Seroprevalence of Hepatitis A and E and Liver Function Abnormalities in Balochistan, Pakistan: A Registry-Based Analysis of 441 Patients Across Pediatric and Adult Populations

Abstract

Background: Hepatitis A virus (HAV) and hepatitis E virus (HEV) are endemic in many regions of Pakistan, including Balochistan, where sanitation challenges and limited vaccination coverage contribute to disease burden. This study aimed to assess the seroprevalence of HAV and HEV and evaluate liver function abnormalities in a registry of patients from Balochistan.

Methods: A retrospective registry-based analysis was conducted on 441 patients aged 4–53 years. Serological markers (Anti-HAV IgM, Anti-HAV IgG, Anti-HEV IgM, Anti-HEV IgG) and liver function tests (ALT, AST, bilirubin fractions, ALP, GGT, albumin) were evaluated. Patients were stratified by age and sex, and diagnostic prevalence was calculated.

Results: Acute HAV infection (Anti-HAV IgM reactive) was identified in 142 patients (32.2%), predominantly among children under 12 years. Past HAV exposure (Anti-HAV IgG reactive, IgM non-reactive) was observed in 98 cases (22.2%), increasing with age. HEV exposure was rare, with 17 cases (3.9%) showing reactive Anti-HEV IgG and no active HEV infections detected. Severe liver injury (ALT >1000 U/L, AST >2000 U/L, direct bilirubin >3.5 mg/dL, elevated ALP and GGT) was documented in 38 cases (8.6%), all associated with acute HAV infection.

Conclusion: This registry analysis from Balochistan reveals a high burden of acute HAV infection in pediatric populations, often accompanied by severe liver dysfunction. Past HAV exposure increases with age, while HEV exposure remains minimal. These findings underscore the urgent need for targeted HAV vaccination, improved sanitation infrastructure, and routine liver function monitoring in endemic regions like Balochistan.