EVALUATION OF AUTOANTIBODIES AND HEPATITIS VIRAL MARKERS IN NIGERIANS WITH LIVER DISEASES

Abstract

Liver disease is a major public health problem. Several diagnostic and aetiologic agents of liver diseases are known, but autoantibodies to liver antigens in Nigerians with liver diseases have not been extensively studied. The study was therefore aimed at detecting the types of autoantibodies and viral antigens in various Iiver diseases among Nigerians. One hundred and twenty six consecutive patients with liver diseases and 82 apparently healthy controls were recruited at UCH lbadan. Clinical features and history of alcohol consumption were documented. Serum samples were analysed for Antinuclear Antibodies (ANA), Antimitochondrial Antibodies (AMA), perinuclear Antineutrophil Cytoplasmic Antibodies (pANCA), anti-Soluble Liver Antigen/Liver Pancreas (anti-SLA/LP) and anti-Liver-Kidney Microsomal-1 (anti-LKM-1) by enzyme linked immunosorbent assay. Similarly, hepatitis B surface antigen (HBsAg), Hepatitis B e Antigen (HBeAg), antibody to HBeAg (anti-HBe), antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis C virus (anti-HCV) were analysed. Hepatitis B virus (HBV) DNA was determined by PCR, and samples positive for HBV s-plasmid DNA by electrophoresis were sequenced for genotypes. Liver function and prothrombin time were determined. Data were analysed using relative frequency, odds ratio, Pearson's Chi square, Fisher's exact test and Students' t-test at 5% level of significance. About 75% were males with mean age of 47.5±14.4 yrs. Sixty one percent had Hepatocellular Carcinoma (HCC), 25.4% Liver Cirrhosis (LC), 7.9% Chronic Hepatitis (Ch), 3.2% Acute Viral Hepatitis (AVH) and 1.6% Primary Biliary Cirrhosis (PBC). Hepatomegaly occurred in 78.6%, ascites in 57.1%, 51.3% consumed significant (≥80g/day for 5 years) alcohol. There was no difference in ANA among cases and controls. AMA was detectable in 60.3% of cases compared to 43.9% of controls (p<0.05). One case and one control were positive for anti-LKM-1 while all subjects were negative for anti-SLA/LP and pANCA. Anti-HBc was detected in 93.7% of cases and 73.2% controls. The prevalence of HBsAg, HBeAg anti-HBe and anti-HCV were significantly higher in cases than controls (p<0.05). The HBV-DNA was higher among cases (46%) than controls (1.2%) (odds ratio 27.3). AVH patients had the highest HBV-DNA viral load with a range of zero to 14 million copies/uL and a mean of 751.86 copies/ uL. Geometric mean HBV-DNA were 63.6, 43.15 and 7.2 copies/uL among cases with LC, HCC and CH respectively. Proportions of CH (40%) and LC (34.4%) with ANA were not significantly higher compared to controls (39.7%), but was significantly higher in HCC patients 61.9% compared to controls, The AMA was significantly higher in CH and HCC compared with controls. HBsAg was significantly higher in HCC compared to controls and other liver cases. HBeAg, anti-HBe, anti-HBc, anti-HCV and HBV-DNA were significantly higher in CH, LC and HCC compared to controls (p-0.05). There were 53 genotype E and two genotype A in cases while only one control had genotype E. Prevalence of autoantibodies to liver antigens is similar in individuals with or without liver diseases and, therefore not reliable in predicting autoimmune liver disease. HBsAg, anti-HBcAg, anti-HBV and HBV-DNA were strongly associated with liver disease. HBV genotype E is predominant in Nigeria.