The Significance of Serologic, Histologic, and Immunohistologic Findings in the Prognosis of 88 Asymptomatic Carriers of Hepatitis B Surface Antigen

Dormeyer, H. H.; Arnold, W.; Schönborn, H.; Braun, B.; Klinge, O; Pfeifer, U; Knolle, J.; Heß, Georg; Kryger, P; Nielsen, Jens; Büschenfelde, K.-H. Meyer zurn

doi:10.1093/infdis/144.1.33

Cited by 35 publications

(10 citation statements)

References 19 publications

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“…Several histologic follow-up studies have also been performed in Taiwan (32)(33)(34) and other areas (35)(36)(37), but there have been few histologic studies in children (8)(9)(10)(11). Several studies on adult asymptomatic HBsAg carriers have shown that histologic lesions in the liver are frequently absent or minor (nonspecific); CPH is occasionally diagnosed, while CAH or cirrhosis is rare.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of asymptomatic hbsag carrier children infected in the perinatal period: Clinical and liver histologic studies

et al. 1988

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Liver histologic findings were studied in 18 children who were 4 to 9 years old, and who had been HBsAg carriers since having been infected by their mothers in the perinatal period. All were born to HBeAg-HBsAg carrier mothers; the children were followed periodically from birth. Throughout their entire course, none developed symptoms or signs suggestive of liver disease. All of the 18 children showed mild but definite liver histologic changes: 15 had nonspecific histologic changes, and three had chronic persistent hepatitis. In 13 of 18 children, follow-up aminotransferase activities were abnormal, but none exceeded 100 KU. At the time of biopsy, ALTs on four children were above the upper limit of normal. All children were HBeAg-positive in early infancy, but five lost this antigen and developed antibody during follow-up. The histologic findings in HBeAg-positive children did not differ from those in children with antibody. Perinatal hepatitis B virus infection has been thought to play an important role in chronic liver disease, including hepatocellular carcinoma. This study indicates that some pathologic changes following perinatal infection begin very early.

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Section: Discussionmentioning

confidence: 99%

Prospective study of asymptomatic hbsag carrier children infected in the perinatal period: Clinical and liver histologic studies

et al. 1988

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“…Its incidence has been estimated to be 0.4% to 2% per year in Western countries, [1][2][3] where HBV infection usually occurs in adults. [1][2][3][4][5][6][7][8][9] In Taiwan, an endemic area of HBV infection that usually occurs perinatally or during early childhood, 10,11 the annual incidence was comparably low, ranging from 0.1% to 0.8%. 12,13 Although several investigators reported a good prognosis for such patients, 1,3,6,14 some reports suggested that cirrhosis may still develop in spite of HBsAg clearance, and some other patients may even progress to hepatocellular carcinoma (HCC).…”

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Sero-clearance of hepatitis B surface antigen in chronic carriers does not necessarily imply a good prognosis

et al. 1998

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The incidence of delayed hepatitis B surface antigen (HBsAg) clearance in the natural history of chronic hepatitis B virus (HBV)-infected patients was low. Previous studies regarding the prognosis in such patients were controversial. Among 1,355 chronic carriers from 1985 to 1997, spontaneous HBsAg clearance was observed in 55 patients. During a mean follow-up period of 23 months, 18 (32.7%; all were male subjects) developed serious complications, including 11 with hepatocellular carcinoma (HCC) (9 of them underwent surgical resection), 6 with cirrhosis, and 1 with subfulminant liver failure. The overall cumulative probability of complications was 29.8% at 4 years, and it was higher in males (P ‫؍‬ .044) and patients aged 45 years or more (P ‫؍‬ .006); the latter carried an 8.6-fold increased risk (95% CI: 1.2-64.6; P ‫؍‬ .037) of adverse events. Histories of acute or chronic infection by hepatitis

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“…Thus The clearance of HBsAg from serum of patients with acute hepatitis B usualIy indicates recovery from infection (1, 2). However, the clinical significance of the disappearance of HBsAg during the course of chronic hepatitis B has not been fully explained because the clearance ratio seems to be very low (3)(4)(5)(6). Although several investigators reported a good prognosis for such patients (3-51, some patients had liver diseases (4,6) and related complications develop.…”

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Clearance of HBsAg in seven patients with chronic hepatitis B

et al. 1992

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The natural history of chronic hepatitis B patients who spontaneously cleared serum HBsAg was investigated. A total of 351 patients with chronic hepatitis B were observed in our hospital for at least 3 yr. Seven of these patients became HBsAg negative during the follow-up period. HBsAg disappeared within 6 mo (range = 11 to 169 days, mean = 70 days) after acute elevation of ALT. ALT levels as high as 500 IU were found in three patients, whereas such elevation was not demonstrated in the other four patients. After the disappearance of HBsAg, ALT levels returned to normal in all patients. With one exception, all patients seroconverted to antibody to HBsAg; however, hepatitis B virus DNA remained detectable in serum using the polymerase chain reaction in five patients. The titer of percent inhibition of antibody to HBcAg gradually decreased to less than 70% when a 1:200 dilution of the serum of six patients was used. Four of the patients had active liver disease develop: two had chronic active hepatitis and two had cirrhosis. Three of these four patients subsequently had hepatocellular carcinoma develop. These findings suggest that patients may suffer complications of chronic hepatitis even after normalization of transaminase activities and after the clearance of HBsAg. Thus hepatitis B virus should be considered as a possible factor associated with hepatocellular carcinoma even in the absence of HBsAg, particularly if serum hepatitis B virus DNA persists.

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The Significance of Serologic, Histologic, and Immunohistologic Findings in the Prognosis of 88 Asymptomatic Carriers of Hepatitis B Surface Antigen

Cited by 35 publications

References 19 publications

Prospective study of asymptomatic hbsag carrier children infected in the perinatal period: Clinical and liver histologic studies

Prospective study of asymptomatic hbsag carrier children infected in the perinatal period: Clinical and liver histologic studies

Sero-clearance of hepatitis B surface antigen in chronic carriers does not necessarily imply a good prognosis

Clearance of HBsAg in seven patients with chronic hepatitis B

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