HEPATITIS B (HBV) SEROLOGICAL MARKERS RELATIONSHIP WITH VITB12 DEFICIENCY

HEPATITIS B (HBV) SEROLOGICAL MARKERS RELATIONSHIP WITH VITB12 DEFICIENCY

Background of the study

Hepatitis B virus (HBV) is one of the most common chronic infections worldwide and the leading cause for hepatocellular carcinoma (HCC) worldwide.Based on WHO (2012) report, one‐third of the world population estimated at about 2 billion individuals are HBV‐infected, including studies showing that about 240 million individuals are chronic carriers (Ado , Alhassan , Chonokoand Samaila 2010). According to Ramia S, Ramlawi F, Kanaan M, Klayme S, Naman R (2015). Transmission of this virus occurs via exchange of bodily fluid such as blood, semen, and perinatal transmission. Hepatitis B has been majorly associated with hepatocellular carcinoma, cirrhosis, and chronic hepatitis, and this makes it identifiable as a major health issue in various developing countries. However an increased rate of this disease occurrence has been recorded in regions like East Asia and sub‐Saharan Africa where 5%‐10% of adults in these locations come up with chronic hepatitis infection as compared to other areas.

Hepatitis has been dubbed a "silent killer" and the world's seventh biggest cause of death, with more than 686,000 fatalities yearly and an estimated 400 million people living with chronic hepatitis infection (Hirnschall, 2015). Although hepatitis has been around for a long time, it was only in 2010 that the World Health Assembly approved Resolution WHA 63.18 to combat the epidemic by lowering new infections and fatalities caused by the illness. According to studies, hepatitis infection is hyperendemic in Nigeria, and the risk of developing the disease is high due to low vaccination rates and the fact that up to 75% of the population may be infected (Majolagbe, Oladipo, & Daniel, 2014; Musa, Bussell, Borodo, Samaila, & Femi, 2015). According to recent reports, the incidence of hepatitis disease in Nigeria is roughly double the national HIV prevalence rate, with 'one in every 12 Nigerians infected with Hepatitis B or C,' with '25 percent of them going on to develop chronic liver diseases, and between 500,000 and 700,000 deaths annually' (Muanya, 2015; Onehi, 2015). This means that if nothing is done urgently to stop the spread of hepatitis among Nigerians, it might kill more people than the deadly HIV/AIDS, necessitating intensive media outreach. Thus  patient of Hypetitis B are often advice to go for serological test.

Remková, A., and Remko, M. (2019) opines that Hepatitis B serologic testing involves measurement of several hepatitis B virus (HBV)-specifi c antigens and antibodies. Different serologic “markers” or combinations of markers are used to identify different phases of HBV infection and to determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or vaccination, or is susceptible to infection. Hepatitis B can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection. HBsAg is the antigen used to make hepatitis B vaccine.

After exposure, HBsAg is the first detectable antigen followed by HBeAg and high levels of serum HBV-DNA are observed. During the natural course of an infection, anti-HBe will arise immediately after HBeAg is cleared, generally causing a decline in viral replication. If the host is able to clear the infection, HBsAg will disappear, anti-HBs and anti-HBc IgG become detectable. Patients who remain HBsAg-positive for at least six months are considered to be hepatitis B carriers (Elghannam, , Goda,  Farag . 2009 cited in Pennap , Aliyu , Odula and Forbi 2016). Thus, Clinical symptoms, elevated serum alanine-transaminase (ALT) levels and positive test result for antiHBc are useful for the diagnosis. ALT level is an important marker of hepatocelluler injury, and is routinely used in the follow-up of the treatment. Elevated ALT is considered to be associated with active liver disease on histology while normal level is considered to be associated with inactive histology.

Greenwood , Slack  and Peutherer  (2000) cited Peng, Chien,  and Liaw. F. (2015) in their study concluded that Hepatitis  B  virus  infection  and PIFN/RBV leads to the decline of B vitamins including vitamin B1, B6, vitamin B12 and folic acid.  it  has  been  documented  that  B  vitamins  could  exhibit  antioxidant  activity  via scavenging oxygen radicals and organic radicals. This decrease in B vitamins diminished their antioxidant defense. On the other hand, Mustufa , Memon , Nasim , Shahid  and Omar  (2010) posits the depletion of B vitamins also favored the occurrence of anemia in HBV patients with PIFN/RBV therapy. It has been shown in an in vitro system that vitamin B12 inhibits HBV IRES-dependent translation, probably by directly interacting with BCV IRES RNA. At the same time, vitamin B12 appears to be biologically significant for HBV replication, as high serum vitamin B12 levels were shown to be associated with high serum HBV-RNA levels in HBV patients. A study by Komas, Baï-Sepou , Manirakiza , Léal, Béré  and Le Faou  (2010) cited in Pennap, Aliyu, Odula  and ForbJ (2016) suggested high serum vitamin B12 levels to be favorable for achieving an end-of-treatment response in HBV patients. Accordingly, they showed in an open-label pilot study that the addition of vitamin B12 to standard-of-care increases clearance of infection rates in treatment naïve HBV patients.

​​​​​​​Statement of the problem

Owing to the high occurrence of Hepatitis in sub-Saharan Africa, it has continued to gain significant interest around the globe, with international institutions joining forces to raise awareness, promote the diseases prevention and  formally designating aside 28 July as the World Hepatitis Day (Onehi, 2015). During this season, problems dealing with causes of hepatitis, its modes of transmission, preventative measures and treatment options are frequently discussed in numerous media platforms and other venues to raise public understanding of the illness.

Muanya, C. (2015) was of the opinion that irrespective of the incidence of new infections and the prevalence of the disease in Nigeria, hepatitis has not been appropriately handled as a severe public health concern. HBV can be associated with type II diabetes mellitus, as HBV outbreaks have been observed among diabetics in healthcare facilities. James ,Obinna Nwankiti,  Joy, Stephen.   Charles,  Oludolapo,  and Victor T. (2019)  in their study  revealed that the overall prevalence of HBV infection among diabetes patients was 13.3%. Breakdown showed 9 (5.0%) seropositivity was obtained among male subjects compared to 15 (8.3%) recorded among the females. Subjects aged 41‐50 years recorded a higher positivity of 7 (3.9%). Risk factors considered showed that 5(2.8%) of the seropositive subjects were alcoholic consumers. Hence they suggested that  general surveillance through routine screening of diabetics in endemic regions with HBV infection is highly advocated to identify those with the hepatitis B infection. Diagnosis of this virus is done by blood screening for the surface antigen. To enable most precise diagnosis and to determine the infectious rate, the diagnosis and follow‐up of chronic hepatitis B virus (HBV) infection relies on laboratory viral biomarkers. There are two major categories of HBV biomarkers. The first one is serology, a term comprising the detection and quantification of viral antigens and viral specific antibodies, and the second is nucleic acid testing (NAT) for the detection and quantification of HBV genome and its RNA transcripts. 

Fialkow,, Wang,  and  Downey, (2007) cited in Gupta, et’al  (2019) asserts that the current treatment of chronic HBV infection includes immunomodulating agents (pegylated interferon-α (PEG-IFN-α)) and several antiviral molecules specifically targeting the virus polymerase  It was speculated that the antioxidant  effect  of B  vitamins  could protect  the  erythrocyte  membrane from  the RBV-induced  hemolysis  and  would  promote  erythropoies  is  in  response  to  the  RBV-induced anemia. Okuda, , Li, , Beard,, et al. (2002) cited in Gupta, et’al  (2019) therefore added that  vitamins B12 have an essential role in neutralizing reactive oxygen species activity and in regulating both innate and adaptive immune response, so that their deficiency is associated with an increased susceptibility to infections. This background represents the rationale to evaluate the relationship between HBV serological markers and VitB12 deficiency. Interestingly, although not limited to hepatic disease of viral aetiology, significant reductions in serum levels of vitamins such as β-carotene, vitamin C, vitamin D and vitamin E in patients with chronic viral hepatitis have been reported, but the underlying mechanisms in B12 have not been elucidated. It is on this note that this study aimed at Hepatitis b (Hbv) Serological Markers Relationship With Vitb12 Deficiency using Federal Medical Centre Enugu as case study.

​​​​​​​Objective of the study

`The broad objective of this study is to examine Hepatitis B (Hbv) Serological Markers Relationship with VitB12 Deficiency using Federal Medical Centre Enugu as case study. Specifically the study seeks:

1. To examine the importance Hepatitis B Survillance.
2. To investigate the Effect of Vitamins on Hepatitis B Infected Patients.
3. To Determine the association between Hepatitis B (Hbv) Serological Markers Relationship With VitB12 Deficiency.

Research Questions

The study is guided by the following questions

1. What is  the importance Hepatitis B Survillance?
2. What is the effect of Vitamins on Hepatitis B Infected Patients?
3. What is  the association between Hepatitis B (Hbv) Serological Markers Relationship With VitB12 Deficiency?

Research hypotheses

Ho: There is no association between Hepatitis B (Hbv) Serological Markers Relationship With VitB12 Deficiency?

Hi: There is a significant association between Hepatitis B (Hbv) Serological Markers Relationship With VitB12 Deficiency?

​​​​​​​Significance of the study

 The result of the study will be beneficial to medical practitioners, patients and government. To nurses and the doctors findings from  this study will is relevant to medicine education because it will enlighten practitioner with  information on the  general knowledge of  Hepatitis B (HBV) Serological Markers Relationship With VitB12 Deficiency among Patients, and how they can improve their immunology through balance intake of Vitamins.  To Hepatitis B patients,  The result of  the study will encourage them on maintaining health practices that would improve their lifestyle and the need to increase surveillance through regular check up in other to function effectively without total breakdown. To government, findings from the study will enable them on the need to create further awareness on the viral Hepatitis B and ensure that they provide policy framework that will sponsor immunization of citizens against Hepatitis. Empirically, the study will add to the body of existing literature and serve as a reference material to both scholars and medical student who wishes to conduct further study in related field.

Scope of the study

The scope of this study is delimited to  Federal Medical Centre in Enugu State. Nurses, Doctors and Hepatitis B Patients in the Federal Government Hospital will be sampled as the respondent for the study. The study will examine how survilance through regular check up will improve Patience lifestyle and take a cursory look at the association between HEPATITIS B (HBV) Serological Markers and Vitamin B12.

Abbreviations:

SVR: Sustained Virological Response

 DAAs: Direct Acting Antiviral Agents

Peg-IFN-α: Pegylated Interferon-α

 RBV: Ribavirin

RVR:  Rapid Virological Response

IRES: Internal Ribosomal Entry Site

HBcAb: hepatitis B core antibodies

HBeAb: Hepatitis B e‐ Antibody

HBeAg:Hepatitis B e‐ Antigen

HBsAb: Hepatitis B surface Antibody

HBsAg: Hepatitis B surface Antigen

HBV: Hepatitis B Virus

T2DM: Type 2 Diabetes Mellitus

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