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Risk factors of transmission and natural history of chronic hepatitis B infection in Iranian patients

Afsaneh Sharifian, Sara Ashtari, Behzad Hatami, Seyed Reza Mohebbi, Nosratollah Naderi




Aims: To investigate routes of transmission, demographic characteristics and frequency of different phases of chronic hepatitis B (CHB) in 2000 Iranian patients.

Background: Knowledge about the most frequent risk factors of CHB and its different phases is very important for optimal prevention and management policy making.

Methods: In this cross-sectional study, 2000 HBsAg positive patients who were referred to Taleghani Hospital from 2011 through 2018 were enrolled. ELISA method was employed to detect serological markers of CHB. Taking into account the HBV DNA and ALT levels and HBeAg status, patients were classified in four groups, according to AASLD 2017 guideline.

Results: Male and female patients had nearly equal frequencies in our study and 82.5 % of them aged more than 20 years. A great number of our patients (95%) were HBeAg negative and the most frequent risk factors of HBV infection were positive periodontal and family history (40.3% and 24.9%, respectively). Majority of our patients were inactive carriers (63.35%) while minority of them were in immune tolerant group (2.15 %).

Conclusion: Immune tolerance phase group had lowest members in our study and most of them were above 20 years old.This can be due to the mass vaccination of neonates since 1993. Most of CHB patients were in inactive carrier group. Although it is recommended not to treat these patients, but performing periodic liver function tests and disease severity assesment is warranted, especially in patients above 40 years old.



Chronic hepatitis B, Risk factors, Natural history, Iran.


Global health sector strategy on viral hepatitis, 2016-2021. Geneva: World Health Organization; Joun 2016. .

Poorolajal J, Majdzadeh R. Prevalence of chronic hepatitis B infection in Iran: a review article. J Res Med Sci 2009;14:249-58.

Mohammadi Z, Keshtkar A, Eghtesad S, Jeddian A, Pourfatholah AA, Maghsudlu M, et al. Epidemiological Profile of Hepatitis B Virus Infection in Iran in the Past 25 years; A Systematic Review and Meta-analysis of General Population Studies. Middle East J Dig Dis 2016;8:5-18.

Shakeri MT, Foghanian B, Nomani H, Ghayour-Mobarhan M, Nabavinia MS, Rostami S, et al. The prevalence of hepatitis B virus infection in mashhad, iran: a population-based study. Iran Red Crescent Med J 2013;15:245-8.

Salehi M, Alavian SM, Tabatabaei SV, Izadi S, Sanei Moghaddam E, Amini Kafi-Abad S, et al. Seroepidemiology of HBV infection in South-East of iran; a population based study. Iran Red Crescent Med J 2012;14:283-8.

Asadi-Lari M, Sayyari AA, Akbari ME, Gray D. Public health improvement in Iran--lessons from the last 20 years. Public Health 2004;118:395-402.

Mohaghegh Shelmani H, Karayiannis P, Ashtari S, Mahmanzar MA, Khanabadi B, Modami N, et al. Demographic changes of hepatitis B virus infection in Iran for the last two decades. Gastroenterol Hepatol Bed Bench 2017;10:S38-s43.

Croagh CM, Lubel JS. Natural history of chronic hepatitis B: phases in a complex relationship. World J Gastroenterol 2014;20:10395-404.

Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 2015;386:1546-55.

McMahon BJ. Natural history of chronic hepatitis B - clinical implications. Medscape J Med 2008;10:91.

Wu JF, Chang MH. Natural history of chronic hepatitis B virus infection from infancy to adult life - the mechanism of inflammation triggering and long-term impacts. J Biomed Sci 2015;22:92.

Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HL, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 2016;10:1-98.

McMahon BJ. The natural history of chronic hepatitis B virus infection. Hepatology 2009;49:S45-55.

Terziroli Beretta-Piccoli B, Schranz M, De Gottardi A, Cerny A. [Update Chronic Viral Hepatitis B and C]. Praxis (Bern 1994) 2015;104:1393-7.

Farhat A, Khademi G, Mazlouman SJ. The prevalence of hepatitis B carrier state in Khorassan province of Iran. Saudi Med J 2003;24:549-51.

Sharifian A, Naderi N, Sanati A, Mohebi SR, Azimzadeh P, Golmohamadi A, et al. The Early Results of a New Health Care Program Implementation in HBV Screening: an Iranian Experience. Middle East J Dig Dis 2015;7:226-32.

Ziaee M, Azarkar G. Prevalence of hepatitis d virus infection among patients with chronic hepatitis B attending birjand hepatitis clinic (East of iran) in 2012. Hepat Mon 2013;13:e11168.

Taherkhani R, Farshadpour F. Epidemiology of hepatitis C virus in Iran. World J Gastroenterol 2015;21:10790-810.

Rostamzadeh M, Afkhamzadeh A, Afrooz S, Mohamadi K, Rasouli MA. Dentists' knowledge, attitudes and practices regarding Hepatitis B and C and HIV/AIDS in Sanandaj, Iran. BMC Oral Health 2018;18:220.

Makvandi M, Soleimani Jelodar R, Samarbafzadeh A, Neisi N, Sharifi Z, Gholampour A, et al. Natural History of Chronic Hepatitis B Virus Infection in Ahvaz City, Iran. Asian Pac J Cancer Prev 2018;19:2125-9.

Merat S, Malekzadeh R, Rezvan H, Khatibian M. Hepatitis B in Iran. Arch Iran Med 2000;3:192-201.

Sali SH, Bashtar R, Alavian SM. Risk factors in chronic hepatitis B infection: A case-control study. Hep Mon 2005;5:109-15.

Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016;63:261-83.

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017.

Sharifi Z. Natural history of chronic hepatitis B virus infection based on laboratory testing. Iran J Public Health 2014;43:990-3.

Keshvari M, Alavian SM, Sharafi H. Comparison of Serum Hepatitis B Virus DNA and HBsAg Levels Between HBeAg-Negative and HBeAg-Positive Chronic Hepatitis B Patients. Jundishapur J Microbiol 2015;8:e21444.

Cunha-Silva M, Marinho FRT, Oliveira PF, Lopes TM, Seva-Pereira T, Lorena SLS, et al. Retrospective analysis of hepatitis B virus chronic infection in 247 patients: clinical stages, response to treatment and poor prognostic factors. Braz J Infect Dis 2017.

Wang L, Zou ZQ, Wang K, Yu JG, Liu XZ. Role of serum hepatitis B virus marker quantitation to differentiate natural history phases of HBV infection. Hepatol Int 2016;10:133-8.

Chen P, Yu C, Wu W, Wang J, Ruan B, Ren J, et al. Serolological Profile Among HBsAg-Positive Infections in Southeast China: A Community-Based Study. Hepat Mon 2013;13:e7604.

Yapali S, Talaat N, Fontana RJ, Oberhelman K, Lok AS. Outcomes of patients with chronic hepatitis B who do not meet criteria for antiviral treatment at presentation. Clin Gastroenterol Hepatol 2015;13:193-201.e1.

Kemal Celen M, Tekin Koruk S, Aygen B, Dal T, Karabay O, Tosun S, et al. The characteristics of patients with chronic hepatitis B in Turkey. Med Glas (Zenica) 2014;11:94-8.

Saikia N, Talukdar R, Mazumder S, Khanna S, Tandon R. Management of patients with HBeAg-negative chronic hepatitis B. Postgrad Med J 2007;83:32-9.

Thompson AJ, Nguyen T, Iser D, Ayres A, Jackson K, Littlejohn M, et al. Serum hepatitis B surface antigen and hepatitis B e antigen titers: disease phase influences correlation with viral load and intrahepatic hepatitis B virus markers. Hepatology 2010;51:1933-44.

Carman WF, Jacyna MR, Hadziyannis S, Karayiannis P, McGarvey MJ, Makris A, et al. Mutation preventing formation of hepatitis B e antigen in patients with chronic hepatitis B infection. Lancet 1989;2:588-91.

Nardone A, Anastassopoulou CG, Theeten H, Kriz B, Davidkin I, Thierfelder W, et al. A comparison of hepatitis B seroepidemiology in ten European countries. Epidemiol Infect 2009;137:961-9.

Chen CJ, Yang HI. Natural history of chronic hepatitis B REVEALed. J Gastroenterol Hepatol 2011;26:628-38.

Hadziyannis SJ. Natural history of chronic hepatitis B in Euro-Mediterranean and African countries. J Hepatol 2011;55:183-91.

Stroffolini T, Almasio PL, Sagnelli E, Mele A, Gaeta GB. Evolving clinical landscape of chronic hepatitis B: A multicenter Italian study. J Med Virol 2009;81:1999-2006.

Zhu H, Liu X, Xue Y, Shen C, Li Y, Wang A, et al. Seroepidemiology of hepatitis B virus infection among Chinese schizophrenia patients. J Infect Dev Ctries 2015;9:512-8.

DOI: https://doi.org/10.22037/ghfbb.v12i0.1841