Chronic active hepatitis. Prolonged survival without treatment

A case is presented of a patient with established HBsAg-positive chronic active hepatitis and cirrhosis of at least 14 years duration. The disease, although untreated, has caused the patient relatively little disability. The implications of the patient's prolonged illness are discussed with reference to current knowledge of chronic active hepatitis. It is concluded that corticosteroid therapy may not be a mandatory requirement for all patients with this disease.

Viral hepatitis: clinical aspects

In the majority of instances acute viral hepatitis resolves totally without sequelae. Fulminant hepatitis is a highly lethal lesion but 20 to 25 per cent of patients, principally young patients, survive. Survivors do not appear to develop chronic liver disease. Persistent viral hepatitis follows acute icteric hepatitis, both type B and non-B, in 10 to 12 per cent of patients. Six long-term HBs Ag carriers demonstrated HBs Ag clearance after 14-73 months. Chronic active viral hepatitis often progresses to cirrhosis. This progressive hepatitis appeared as a sequelae of acute icteric type B hepatitis in 3 per cent of 429 patients. In patients with chronic active type B hepatitis, low titers of HBs Ag are common.

Serum hepatitis after open-heart surgery

Ten cases of serum hepatitis occurring after open-heart surgery at the National Heart Hospital, London are reported. The incidence seemed to be rising and was at least 2% before antigen-screened blood became available. Investigation of 135 patients for the presence of Australia antigen and antibody showed that five (3·7%) had responses to exposure to the infective agent. All were and remained clinically well, but such patients may constitute a source of infection. Since tested blood has been used no hepatitis cases have been recognized.

Haemodialysis-associated hepatitis

Outbreaks of hepatitis have occurred in renal units all over Europe and the U.S.A. and have carried a high mortality.

This is an iatrogenic disease, transmitted by blood from carriers of SH virus, uraemic patients often suffering subclinical attacks.

The risks to the staff of these units are so high that they should not be asked to undertake this work if outbreaks cannot be controlled.