Comparative Analysis of Serum Trace and Heavy Metals in Hepatitis B, C, and D Patients from Shaheed Benazirabad, Pakistan

Trace and heavy metals play essential roles in liver metabolism and immune regulation, but their imbalance may exacerbate complications in viral hepatitis. Objectives: To compare serum levels of key trace elements (zinc [Zn], iron [Fe], copper [Cu]) and heavy metals (lead [Pb], cadmium [Cd], chromium [Cr], aluminum [Al], arsenic [As], manganese [Mn], nickel [Ni], cobalt [Co]) among patients with Hepatitis B (HBV), Hepatitis C (HCV), and Hepatitis D (HDV). Methods: A cross-sectional study was conducted on 130 patients (aged 15–70 years) in Shaheed Benazirabad, Pakistan (2022–2024). Serum metals were quantified using Flame and Graphite Furnace Atomic Absorption Spectrometry (FAAS/GFAAS). Statistical analyses included ANOVA/t-test for normally distributed data and Kruskal–Wallis/Mann–Whitney U for non-normal data. For metals with concentrations reported below the method's limit of detection (LOD), a value of half the LOD (LOD/2) was assigned for statistical analysis. This common strategy minimizes bias and allows for the inclusion of all data points in the analysis, preventing the loss of information that would occur from exclusion. Results: Cr was significantly elevated in HCV compared to HBV (p=0.0035). Manganese (Mn) was significantly reduced in HDV compared to HBV (p=0.011). Other metals (Zn, Fe, Cu, Pb, As, Al, Cd, Ni, Co) showed no statistically significant differences, although trends of accumulation were observed. Conclusions: Elevated chromium in HCV and reduced manganese in HDV suggest that hepatitis type influences metal homeostasis, potentially contributing to disease progression.