We assessed prognostic factors in 115 patients with serologically defined fulminant hepatitis B. The diagnosis in each case was based on the finding of IgM antibody to the hepatitis B core antigen in serum. Multivariate analysis showed that factor V level (p less than 0.001), patient's age (p = 0.001), absence of detectable HBsAg by radioimmunoassay (p = 0.06) and serum alpha-fetoprotein concentration (p = 0.07) were independent predictors of survival. The survival rate in the 21 patients in whom HBsAg was not detected was 47%, which was significantly higher than the survival rate of 17% observed in the 94 HBsAg-positive patients (p = 0.006). In patients with fulminant hepatitis B, the absence of HBsAg in serum as detected by radioimmunoassay has an independent, favorable prognostic value.
There is no reliable and simple diagnostic marker available to diagnose recent hepatitis C virus (HCV) infection. It has been shown that the avidity of specific IgG antibody is low in primary viral infection and increases with time. We report the development of an anti-HCV avidity assay derived from a commercially available test. A panel of 117 sera was first examined for IgG avidity. It was composed of samples from patients with recent (group 1, n ؍ 14), chronic (group 2, n ؍ 70), and resolved (group 3, n ؍ 33) HCV infections. Avidity index (AI) values observed in recently infected patients were significantly lower (12.0% ؎ 9.2% [mean ؎ standard deviation]) than those found in chronic carriers (83.1% ؎ 15.2%). Using a threshold of 43.0%, this assay distinguished between groups 1 and 2 with very high sensitivity (98%) and specificity (100%). For group 3, a broader distribution of the AI values was observed (54.8% ؎ 27.3%), suggesting that this index would not be useful in HCV RNA-negative patients. Blind validation of the test was carried out with a panel of 36 serum samples from 17 HCV seroconverters. The assay described here is a useful tool to distinguish recent from chronic infection in HCV-viremic patients.
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