Uncovering silent carriers: Hematological insights and viral burden in incidentally detected hepatitis B virus infection

doi:10.4254/wjh.v18.i1.113247

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Jan 27, 2026 (publication date) through Jan 27, 2026

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Hepatol. Jan 27, 2026; 18(1): 113247
Published online Jan 27, 2026. doi: 10.4254/wjh.v18.i1.113247

Uncovering silent carriers: Hematological insights and viral burden in incidentally detected hepatitis B virus infection

Manisha M Ratnaparkhi, Chanda R Vyawahare, Parag J Ratnakar, Nageswari R Gandham, Poonam V Suryawanshi

Manisha M Ratnaparkhi, Chanda R Vyawahare, Nageswari R Gandham, Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre and Dr. D. Y. Patil Vidyapeeth, Pune 411018, Mahārāshtra, India

Parag J Ratnakar, Central Clinical Laboratory, Dr. D. Y. Patil Medical College, Hospital and Research Centre and Dr. D. Y. Patil Vidyapeeth, Pune 411018, Mahārāshtra, India

Poonam V Suryawanshi, Central Research Facility, Dr. D. Y. Patil Medical College, Hospital and Research Centre and Dr. D. Y. Patil Vidyapeeth, Pune 411018, Mahārāshtra, India

Author contributions: Ratnaparkhi MM was responsible for concept and design of the study, manuscript writing; Ratnaparkhi MM, Vyawahare CR, and Suryawanshi PV contributed to statistical analysis; Ratnaparkhi MM and Suryawanshi PV were contributed to methodology; Ratnaparkhi MM, Vyawahare CR, and Gandham NR contributed to literature search; Vyawahare CR edited the manuscript; Ratnakar PJ was involved with collection and testing of the clinical samples; Gandham NR was responsible for data interpretation; Ratnaparkhi MM, Vyawahare CR, Ratnakar PJ, Gandham NR, and Suryawanshi PV finalized manuscript. All authors have reviewed and approved the manuscript.

Institutional review board statement: The study was conducted following approval from the Institutional Ethics Committees. Approval references included IESC research from Dr. D. Y. Patil Medical College, Hospital and Research Centre and Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India (approval No. I.E.S.C/163/2023).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon request via email chandavyawahare@dpu.edu.in.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Chanda R Vyawahare, MD, Professor, Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre and Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune 411018, Mahārāshtra, India. chandavyawahare@dpu.edu.in

Received: August 20, 2025
Revised: September 11, 2025
Accepted: November 25, 2025
Published online: January 27, 2026
Processing time: 160 Days and 16 Hours

Abstract

BACKGROUND

Hepatitis B Virus (HBV) remains a global public health challenge, affecting over 296 million people, many of whom are asymptomatic. Incidentally diagnosed carriers provide a critical window for early intervention and prevention. Understanding their hematological profile and viral burden can help inform risk assessment and clinical management.

AIM

To evaluate hematological parameters and HBV viral load in incidentally detected asymptomatic hepatitis B surface antigen positive patients during routine health screenings.

METHODS

A cross-sectional observational study was conducted from June 2024 to March 2025 at Dr. D. Y. Patil Medical College, Hospital and Research Centre a tertiary care hospital in Pune, Maharashtra, India, involving 100 hepatitis B surface antigen-positive patients and 20 healthy controls. Hematological and liver function parameters were assessed, and quantitative HBV DNA analysis was performed using real-time polymerase chain reaction. Statistical analysis was conducted using GraphPad Prism v8.0.

RESULTS

Marked variations were detected in hemoglobin levels (P < 0.0001), percentage of neutrophils (P = 0.0006), percentage of lymphocytes (P = 0.0031), serum glutamic-oxaloacetic transaminase activity (P = 0.0013), and alanine aminotransferase levels (P = 0.0001) when comparing HBV-infected individuals with the control group. Conversely, differences in total leukocyte count, percentage of monocytes, percentage of eosinophils, platelet count, total bilirubin, and serum glutamic-pyruvic transaminase values were not statistically significant. Viral load > 2000 IU/mL was found in 17 patients, and < 2000 IU/mL in 24 patients. Viral load positively correlated with conjugated bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, and alkaline phosphatase, and negatively with albumin and the albumin-globulin ratio.

CONCLUSION

Incidentally detected HBV infections present an opportunity for early disease detection. Hematological and viral markers can guide clinical decisions. Routine screening and contact tracing are essential strategies to control HBV transmission and progression.

Keywords: Hepatitis B; Hepatitis B virus deoxyribonucleic acid quantification; Hematological biomarkers; Liver function tests; Viral load; Subclinical hepatic injury

Core Tip: A substantial proportion of hepatitis B virus infections remain undetected due to the asymptomatic nature of silent carriers. This study reveals that incidentally diagnosed hepatitis B surface antigen-positive individuals exhibit significant alterations in hematological and liver function parameters despite lacking clinical symptoms. Findings demonstrate a correlation between viral load and markers of hepatic injury, highlighting the need for vigilant laboratory monitoring. Early identification of subclinical liver involvement offers a critical window for intervention to prevent long-term complications such as cirrhosis and hepatocellular carcinoma. This work underscores the importance of integrating routine screening, hematological profiling, and virological assessment in public health strategies targeting hepatitis B virus control.