TITLE:
Serological Marker Profiles of Chronic Hepatitis B Virus Infection among HBsAg-Positive Patients Seeking Medical Care in the North Rift Region of Kenya
AUTHORS:
Joseph Osoga, Lilian Ogonda, Samwel Omari, Millicent Orido, Elizabeth Moraa, Damaris Matoke-Muhia, Carolyne Kifude, Missiani Ochwoto
KEYWORDS:
Hepatitis B Virus, Chronic Infection, Viral Load, Tenofovir, Entecavir, Serological Markers
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.16 No.2,
June
29,
2026
ABSTRACT: Background: Serological marker and viral load testing in hepatitis B virus (HBV) infection is essential for accurate diagnosis, interpretation of serological profiles and infectivity, guiding treatment, and monitoring patient progress. In Baringo County, Kenya, the HBV prevalence of 10.8%, exceeds the national average of 3%, indicating a hyperendemic focus. Despite the adoption of World Health Organization (WHO) HBV treatment guidelines at Moi Teaching and Referral Hospital and Marigat Sub-County Hospital in 2017, routine use of serological markers and viral load testing remains limited in clinical practice. Methods: This cross-sectional study included 65 chronic HBV patients receiving treatment at Moi Teaching and Referral Hospital and Marigat Sub-County Hospital. Plasma samples were analyzed for HBsAg, HBsAb, HBeAg, HBeAb and HBcAb-IgM using the Quick ProfileTM HBV-5 panel Test. HBV DNA viral load was quantified by quantitative real-time polymerase chain reaction (qPCR). Descriptive statistics were used to summarize the distribution of serological markers, while viral load results were expressed as medians with interquartile ranges (IQR). The Chi-square test was used to assess categorical distributions. Results: All 65 (100%) subjects were found to have HBsAg, confirming chronic HBV infection. The most frequent pattern was HBsAg (+), HBsAb (–), HBeAg (–), HBeAb (–), HBcAb-IgM (–) and was seen in 31 patients (47.7%). This profile was typical of chronic Hepatitis B infection with no evidence of acute activity or HBeAg seroconversion in the last several months. HBV DNA levels were relatively low in this group with a median of 509 copies/mL (IQR: 28.7 - 14,231) with some variation in viral load seen in many individuals, mostly low-replicative. Twenty-three-point one percent (23.1%) of patients were HBcAb-IgM positive, which is an active immune response and suggests viral reactivation. HBeAb positivity without HbcAb-IgM was detected in 21.5%, which is in line with HBeAg-negative serological profile with persistent viral replication. 7.7% of participants were co-positive for HBsAb and HBsAg, indicating partial immune control. The median viral loads were significantly different between serological profile: lowest for HBcAb-IgM positive patients, 162 copies/mL (IQR: 28 - 1,500,000); highest for HBeAb positive without HBcAb-IgM, 17,589 copies/mL (IQR: 118 - 27,353,162); and intermediate for those with both HBsAb and HBsAg positivity, (1642 copies/mL IQR: 567 - 11,466). Conclusion: The serological and viral load profile were very diverse, indicating different serological patterns and immune responses within this hyperendemic population. Regularly performed serological and viral load assays are important for proper disease staging and management. Improving the diagnostic capacity will allow for targeted treatment and augment public health interventions.