Disease Pattern And Diagnostic Accuracy Of Th 1 And Th 2 Cytokines In Hepatitis B Virus Infected Patients: A Case Control Study In Ghana

Abstract

Background: The host immune response to hepatitis B viral (HBV) infection affect the clinical outcome. Cytokines inhibit HBV replication and influences the clinical outcome of HBV infection. This study sought to determine the disease pattern of Th1, Th2 and immunosuppressive cytokines and their diagnostic accuracy in classifying or staging HBV infection. Method: In a case control study, patients with HBV infections and healthy blood donors were screened for HBsAg profile, HCV and HIV. Those positive with HCV and HIV were excluded. Finally, 120 HBV infected patients and 105 healthy blood donors were recruited as cases and control. Th1 cytokines (IL- 12p70, IFN-γ and TNF-α), Th2 cytokines (IL-4, IL-6) and immunosuppressive cytokine (IL-10) were assayed by ELISA. Their diagnostic performance were determined using the ROC curve. Results: The HBsAg serological profile results gave 3 acute infections, 12 HBV recovery, 5 positive chronic hepatitis B (CHB) and 100 negative CHB. Median levels of IL-12p70, TNF-α and IFN-γ were elevated in HBV infections compared to controls (p>0.05). Median levels of IL-4 was significantly elevated in HBeAg negative CHB and HBV recovery compared to controls (p=0.0196) whilst IL-10 was significantly elevated in HBeAg negative CHB infection (p=0.0253). At 95% confidence interval, the best diagnostic markers with AUC, sensitivity and specificity were IL-10 (0.72, 66.67% and 86.67%) for acute infection and 0.66, 67.0% and 60.0% for HBeAg negative CHB. IL-4 (0.72, 66.67% and 84.44%) for HBV recovery and IL-6 (0.75, 80.0% and 71.1%) respectively for HBeAg positive CHB respectively. Conclusion: Th2 cytokines (IL-4, IL-6) and immunosuppressive cytokine (IL-10) are better diagnostic markers for classifying the various stage of HBV infections. Increased IL-4 is associated with both HBV recovery and HBeAg negative CHB whilst increased IL-10 is related to HBeAg negative CHB. The measurement of these cytokines may lead to improvements in the clinical management of HBV infected patients based on their defined cytokine profiles.