G. Realdi

Chronic evolution of acute hepatitis type B: Prevalence and predictive markers

SummaryDuring a prospective study of acute symptomatic viral hepatitis, started in 1978, 664 consecutive adult patients, including 223 drug abusers, fulfilled the diagnostic criteria (anti-HBc IgM positivity) for acute type B hepatitis. In order to evaluate the outcome of the disease, 443 patients were followed for up to 12 months after the onset. 2.4% of the infections became chronic; the rate did not significantly differ between drug addicts and non-drug abusers, suggesting that chronic hepatitis is a rare complication of acute symptomatic hepatitis type B. Ongoing liver damage after clearance of HBsAg from serum was observed in drug abusers only (14% of the cases). Clinical, biochemical and virological features of the acute phase in patients with ongoing infection were compared with those of uncomplicated cases. Anicteric hepatitis and lower transaminase values were significantly (p<0.05) associated to a chronic evolution of the disease, as well as a higher prevalence of HBV-DNA, DNA polymerase and HBcAg positivity in serum. Testing HBV-DNA and DNA polymerase early in the course of the infection appeared to be of high predictive value for the subsequent outcome of the illness.ZusammenfassungIm Verlauf einer 1978 begonnenen, prospektiven Studie über die akute symptomatische B-Virus-Hepatitis wurde die Diagnose bei 664 Patienten gesichert (anti-HBc IgM-positiv); in dieser Gruppe waren 223 Drogensüchtige und 441 Nicht-Drogensüchtige. Verlaufsbeobachtungen erfolgten bei 443 der Patienten bis zu 12 Monate nach Ausbruch der Krankheit. 2,4% der Infektionen nahmen einen chronischen Verlauf, dabei bestanden zwischen den Drogensüchtigen und Nicht-Drogensüchtigen keine signifikanten Unterschiede. Dies deutet darauf hin, daß die akute symptomatische B-Virus-Hepatitis nur selten in die chronische Form übergeht. Ein Fortschreiten der Leberschädigung nach dem Verschwinden von HBsAg aus dem Serum wurde nur bei Drogensüchtigen (14% der Fälle) beobachtet. Die klinischen, biochemischen und virologischen Parameter der akuten Krankheitsphase wurden bei Patienten mit persistierender HBV-Infektion und bei Patienten mit unkompliziertem Verlauf verglichen. Eine anikterische Hepatitis und niedrigere Transaminasenwerte sowie eine höhere Prävalenz der HBV-DNA, DNA-Polymerase und HBcAg-Positivität waren signifikant mit einem chronischen Verlauf assoziiert (p<0,05). Die Testung der HBV-DNA und DNA-Polymerase in der Frühphase der Infektion hat sich als sehr wertvoll für die Prognose des weiteren Krankheitsverlaufes erwiesen.

A 7 year survey of acute hepatitis type B.

Epidemiological and clinical features of acute symptomatic hepatitis type B were evaluated in 51 otherwise healthy children and in 13 children receiving immunosuppressive treatment for leukaemia and malignancy, who were admitted to hospital with acute hepatitis B surface antigen (HBsAg) positive hepatitis during a period of 7 years. Blood transfusions, or intimate contacts with asymptomatic HBsAg carriers or with contaminated material during repeated admission to hospital were the possible sources of infection in the immunosuppressed patients, whereas percutaneous exposure was identified as the source in a minority of non-immunosuppressed patients. Features of the acute phase of the illness differed little between the two groups of patients (acute liver failure developed in one patient with leukaemia and in two untreated children). Conversely, chronic evolution was observed in 69% of immunosuppressed patients but in only 9% of untreated children and affected only patients born to HBsAg positive mothers (two of four patients) or patients presenting with papular acrodermatitis (both patients).

Prognosis of chronic hepatitis B transmitted from HBsAg positive mothers.

Nine children born to HBsAg positive mothers, who became chronic HBsAg carriers with associated liver disease, were followed for five to 10 years. Five children with active hepatitis or active cirrhosis at presentation achieved complete remission within six years, while three HBeAg positive patients with minimal histological lesions remained unchanged.

Circulating hepatocyte membrane-specific autoantibodies in chronic active hepatitis type B. Relation to virus replication activity and liver cell necrosis.

Sera from two groups of untreated HBsAg-positive patients with chronic active hepatitis on liver biopsy were tested for antibodies to liver cell membrane antigens (liver-specific protein, LSP; and liver membrane antigen, LM-Ag). Among the 14 HBeAg-positive cases, seven (50%) were positive for anti-LSP, whereas only two (13%) of 15 anti-HBe-positive cases circulated this antibody. Liver membrane autoantibody (LMA) was detected only in two sera from delta-positive patients (1 HBeAg positive and 1 anti-HBe positive). Anti-LSP-positive patients presented transaminase values significantly higher than those of the negative cases. Our data do not support the hypothesis that a liver-specific autoimmune mechanism plays a significant role in the immunopathogenesis of liver cell necrosis in anti-HBe-positive chronic active hepatitis type B. The relationship between hepatocyte necrosis and anti-LSP antibody response is confirmed.