Immunological findings during successful treatment of HBsAg-associated polyartheritis nodosa by plasmapheresis alone.

Chronic type B hepatitis and the “healthy” Hbsag carrier state

“…Thus, "healthy" HBsAg carriers rarely transmit infection to others (49) and usually do not have progressive liver disease (32,50). The immune complex disorders associated with HBV infection are generally found only in patients with active viral replication, and loss of HBeAg and serum HBV DNA in these patients is usually followed by a remission in the immune complex disease (51,52). Finally, a highly controversial question is whether "healthy" HBsAg carriers are at a lower risk (53).…”

Hepatitis B as an Immune Complex Disease

“…Pathologic features of the arteritis include fibrinoid necrosis and perivascular infiltration of medium and small arteries and arterioles; in a proportion of these patients, the vascular lesions are more characteristic of a "hypersensitivity angiitis." Although response to anti-inflammatory and immunosuppressive therapy is unpredictable, encouraging results with the use of cyclophosphamide or plasmapheresis have been reported (see below) [10,20]. Immunologic studies, similar to those described above in patients with the serum sickness-like syndrome, suggest an immune complex-mediated pathogenesis for the systemic vasculitis associated with HBV infection.…”

“…Moreover, the spontaneous remission rate in children with HBV and membranous GN approaches 50% [33]. Fauci et al [20] found a dramatic response to cyclophosphamide in 17 patients with systemic necrotizing vasculitis, six of whom had hepatitis B antigenemia, and Chalopin et al [10] treated one HBsAg-positive patient with systemic vasculitis successfully by plasmapheresis alone. Perhaps the most direct approach to the therapy of these disorders would be to eliminate the viral infection; in the future, antiviral agents such as interferon and adenine arabinoside (Ara-A) may find a place in the management of these patients.…”

Indications of Plasma Exchanges for Systemic Vasculitides

“…For several decades, an overall improvement of the prognoses for polyarteritis nodosa (PAN) and Churg–Strauss syndrome (CSS) have been observed as a direct consequence of the systematic use of corticosteroids (CS) and extensive use of cyclophosphamide (CYC) (1–4). In the early 1980s, PE was widely prescribed to treat PAN (5–8). Because PE is able to remove immune complexes and improve the capacity of the reticuloendothelial system to clear these complexes (9), PE was effective and was able to successfully treat patients with PAN related to hepatitis B virus (HBV) (7) and to improve the course of PAN after failure of CS and CYC (6).…”

“…In the early 1980s, PE was widely prescribed to treat PAN (5–8). Because PE is able to remove immune complexes and improve the capacity of the reticuloendothelial system to clear these complexes (9), PE was effective and was able to successfully treat patients with PAN related to hepatitis B virus (HBV) (7) and to improve the course of PAN after failure of CS and CYC (6).…”