Hidden Burden of Hepatitis B: High Viral Loads among Asymptomatic Carriers in India

Introduction: Hepatitis B virus (HBV) infection remains a major public health issue in India, with a significant burden of undiagnosed asymptomatic carriers. Identifying such individuals is essential to achieve the World Health Organization’s goal of HBV elimination by 2030. Methods: The objectives of this study were to determine the prevalence of hepatitis B surface antigen (HBsAg) and HBV viral load among asymptomatic healthcare workers and patients undergoing elective surgeries and to evaluate the need for universal HBV screening in such populations. This was a hospital-based cross-sectional study conducted at a tertiary care center in Central India. Blood samples from 13,840 asymptomatic individuals were tested for HBsAg, and positives in HBsAg were further tested for hepatitis B e antigen (HBeAg) by enzyme-linked immunosorbent assay. HBV DNA quantification was performed using a real-time polymerase chain reaction-based method on selected samples. Results: Out of 13,840 individuals screened, 355 (2.57%) tested positive for HBsAg. Among these, 37 (10.42%) were HBeAg-positive, all of whom had HBV DNA levels > 2000 IU/ml. Notably, 48.64% of HBeAg-negative individuals also had significant viral loads. The average age of HBsAg-positive individuals was higher than negatives (42.38 ± 16.58 vs. 37.52 ± 18.92; P = 0.008). Males were more frequently infected (P < 0.001). Conclusion: The study highlights a significant proportion of asymptomatic individuals with elevated HBV viral loads, particularly among HBeAg-negative cases. These findings support the implementation of universal HBV screening in preoperative and occupational health settings as a vital strategy for early detection, treatment initiation, and achieving national and global HBV elimination targets.