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

The current study sought to assess the levels of alanine aminotransferase and immune-hematological alterations as an adjunct marker in HBV management where viral load testing is not available or prohibitively expensive. A case-control cross-sectional study was conducted among 300 subjects (acute and chronic HBV-positive cases with matched HBV-negative individuals grouped in the ratio of 1:1:1). The hematological parameters, absolute CD4+ T-cell count, alanine aminotransferase (ALT), and HBV-DNA were measured using standard methods. Cases were grouped into acute or chronic HBV subjects using qualitative laboratory tests. Results show anemia prevalence to be the highest (67% of acute and 72% of chronic HBV cases) followed by lymphopenia. Our data analysis shows normocytic normochromic anemia in both HBV cases. All variables analyzed in acute and chronic HBV-positive cases had comparable increased or decreased median levels except for viral hepatitis B load (chronic 903 (IQR 298–8 × 10 5 ] vs acute 211 (IQR 50–820); p <0.001). Interestingly, red blood cell ( τ = − 0.2, p < 0.05) and platelet ( τ = − 0.3, p < 0.01) levels were negatively correlated with the HBV-DNA in acute HBV-infected cases only. However, increasing viral hepatitis B load was associated with a decreased CD4+ T-cell count and increased ALT. Our findings highlight the cytopathic impact of HBV infection on the peripheral blood cells as manifested by the high prevalence of anemia and their correlation with increasing viral load. As such, these parameters could be useful as adjunct markers for viral load in the management of HBV infection in a resource-constrained setting.