Cadmium, Arsenic And Lead Levels In Persons With Chronic Hepatitis B In The Ejura-Sekyedumase District, Ghana.

ABSTRACT

Introduction: Chronic hepatitis B (CHB) increases the risk of liver dysfunction and leads to complications such as cirrhosis and hepatocellular carcinoma (HCC). The rate of progression of CHB to these complications is attributed to hepato-toxicants, including heavy metals. Some heavy metals such as selenium and zinc have hepatoprotective benefits. However, others such as cadmium, arsenic and lead are hepatotoxic. The aim of this study was to measure the levels of cadmium, arsenic and lead in persons with CHB in the Ejura-Sekyedumase District (ESD) of the Ashanti region of Ghana. 

Subjects, Materials and Methods: Eighty-two (82) subjects (comprising 41 CHB subjects and 41 controls) participated in the study. The CHB subjects were recruited from the Ejura-Sekyedumase District (ESD) hospital and 41 controls from the ESD community. Urine samples were collected for the measurement of cadmium, arsenic and lead. Blood samples were drawn for the measurement of total bilirubin, direct bilirubin, ALT, AST, Total protein, and Albumin. Sera from the blood were also analyzed for HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb. 

Results: Compared with the controls, the CHB subjects had significantly elevated levels of urinary cadmium (p = 0.004), total bilirubin (p = 0.030), direct bilirubin (p = 0.031) and ALT (p = 0.005). However, there was no significant difference between the levels of albumin (p=0.105) and AST (p = 0.224) in the CHB subjects and controls. There was no association between the urinary cadmium levels and ALT or AST (r2= 0.003). However, there was a weak positive correlation between the urinary cadmium levels and serum total bilirubin (r2 = 0.024). There was a weak positive correlation between the urinary arsenic concentration and ALT concentration (r2 = 0.072) and AST concentration (r2 = 0.062), however no correlation between the urinary arsenic concentrations and serum total bilirubin (r2 = 0.018). There was a weak positive correlation between the urinary lead concentrations and ALT concentration (r2 = 0.065) and total bilirubin concentration (r2 = 0.063), but no correlation between the urinary lead concentration and AST concentration (r2 = 0.041). 

Conclusion: It is concluded that cadmium levels are high in persons with CHB than in persons without CHB. The study asserts that cadmium acts synergistically with HBV to cause its significantly high levels in CHB subjects and the HBV impairs liver function, making it difficult for the liver to detoxify cadmium.