Persistent infection of humans with hepatitis B virus: mechanisms and consequences

Although most infections of humans with hepatitis B virus are self-limited, up to 10% of individuals experiencing primary infection remain persistently infected. These individuals are usually asymptomatic but may suffer episodic or progressive liver injury that can result in cirrhosis and liver failure. In addition, chronic infection with hepatitis B virus is, in certain settings, associated with the late development of primary hepatocellular carcinoma. This review summarizes the biological characteristics of persistent viral infection, with particular emphasis on host and viral factors that affect the outcome of primary infection.

Dane particle-associated hepatitis B e antigen in patients with chronic hepatitis B virus infection and hepatitis B e antibody

A commercial radioimmunoassay was adapted to detect serum Dane particle-associated HBeAg in patients whose sera contained homologous antibody. HBeAg was released from Dane particles with guanidine HCl. Dane particles were separated from anti-HBe by gel-filtration (Sepharose 4B) and ultracentrifugation of the eluate. Dane particle-HBeAg was tested in 45 HBsAg carriers with anti-HBe and was present in 8 (18%) carriers, all of whom had chronic liver disease. By contrast, HBeAg was not found in 10 carriers with normal liver histology. Serum or liver HBcAg was found in 6 of 8 patients with Dane particle-HBeAg. None of the carriers without Dane particle-HBeAg had other markers of hepatitis B virion synthesis. We conclude that Dane particle-HBeAg provides a sensitive index of active hepatitis B virus replication, a guide to the presence of chronic hepatitis in HBsAg carriers with anti-HBe, and a noninvasive method to follow infection in these patients.

Prognosis of hepatitis B virus surface antigen carriers in relation to routine liver function tests: a prospective study

The employees of the Japan National Railways Co. working in the Tokyo area, comprising 98% men over the age of 40 yr, were examined for hepatitis B virus seromarkers and routine liver function tests (serum glutamic oxaloacetic transaminase, alkaline phosphatase, and zinc turbidity test) and were followed for 5 yr. The examinees included 202 hepatitis B surface antigen carriers, 502 positive for hepatitis B surface antibody, and 2426 negative for both. We found that the frequency of continuously abnormal liver function test was higher in hepatitis B surface antigen carriers compared with noncarriers. Of the 202 carriers, 4 (1.98%) died from hepatocellular carcinoma with or without cirrhosis, whereas in 2928 noncarriers only 2 (0.07%) died from liver diseases unrelated to hepatitis B virus, the difference being 28.3-fold. Three of the 4 who died from hepatocellular carcinoma initially had normal liver function tests. Mortality in carriers with initially normal liver function tests was 44.5 times higher than that in noncarriers with normal tests. Thus, asymptomatic carriers carry a high risk of dying from chronic liver disease. Routine liver function tests appear of limited value in predicting prognosis.

Thyroid function tests in patients with acute and resolved hepatitis B virus infection

Serum thyroid hormones and thyroid hormone binding were sequentially measured in 20 patients with acute hepatitis B infection. Criteria to select patients consisted of a positive test for hepatitis B surface antigen, aspartate aminotransferase (AsAT) concentration greater than 400 U/L during the acute illness, and available serum specimens after recovery. The mean serum thyroxine (T4) concentration (+/- SE) was 12.5 +/- 0.6 microgram/dL during acute infection and 7.4 +/- 0.3 microgram/dL after recovery (p less than 0.001), whereas mean free T4 index values did not significantly differ. The mean serum thyroxine-binding globulin (TBG) concentration was significantly increased (p less than 0.001) during acute illness and accounted for the reversible of serum and the increased serum T4 concentrations. The rise in serum TBG correlated with the rise in AsAT during the acute illness (p less than 0.04) suggesting nonspecific release of these proteins from injured hepatocytes. The mean free triiodothyronine (T3) index was decreased during acute hepatitis (p less than 0.001) and returned to normal after recovery, indicating that acute hepatitis B infection, like other nonthyroidal illnesses, is associated with decreased T4 to T3 conversion in peripheral tissues.

Guillain-Barré syndrome complicating acute hepatitis B. A case with detailed electrophysiological and immunological studies

A 61-year old man was seen for Guillain-Barré syndrome (GBS) complicating acute type B hepatitis. Results of detailed electrophysiological studies were characteristic of a severe peripheral neuropathy of the segmental demyelinating type. Immunological studies demonstrated cell-mediated sensitization to peripheral nerve basic protein. Twenty-six cases of GBS complicating viral hepatitis were analyzed for age, sex, temporal relationship of the onset of the hepatitis to that of the polyneuritis, and outcome.

The HBe antigen-antibody system and its relationship to clinical and laboratory findings in 100 chronic HBsAg carriers in Great Britain

HBeAg or anti HBe were detected using radioimmunoassay in 93 out of 100 British patients who were chronic HBsAg carriers. HBeAg was found more commonly than anti HBe in younger patients and those with higher titres of HbsAg and abnormal liver function tests. HBeAg was present particularly in patients with chronic active hepatitis (26 out of 29) and chronic persistent hepatitis (16 out of 21). Anti HBe was found particularly in healthy carriers (19 out of 27), and patients with cirrhosis (4 out of 8) and hepatocellular carcinoma (7 out of 8). However, the system was of little help in predicting the liver biopsy appearances in the individual patient. During a mean follow-up period of 44 months, 6 of the 62 (9.7%) HBeAg positive carriers converted to anti HBe, a spontaneous seroconversion rate of 2.68% per year.

Chronic hepatitis in chimpanzee carriers of hepatitis B virus: morphologic, immunologic, and viral DNA studies

Years after infection with hepatitis B virus, chimpanzees may have manifestations of the carrier state as described in man. In addition to serologic evidence for persistent viral infection, percutaneous liver biopsy specimens showed hepatitis B virus surface antigen in the cytoplasm and hepatitis B virus core antigen in the nucleus. Four carrier animals had portal inflammatory reaction as seen in human chronic persistent hepatitis. Viral DNA was demonstrated in nucleic acid extracts of liver biopsy specimens by molecular hybridization to cloned plasmic pA01 containing hepatitis B virus DNA sequences. Although a viral molecule of length greater than the putative virus was identified, it did not appear to represent integration of viral DNA into the host genome. The chimpanzee model may serve as a means to study the mechanism of hepatitis B viral persistence and progression to chronic liver disease.

Active chronic viral hepatitis type B in a 10-month-old child

A case of active chronic viral hepatitis type B in a ten-month-old child is described. The condition is attributed to an exchange transfusion performed because of Rh incompatibility after which the child developed severe liver disease.

Hepatitis. A review of the disease and its significance to dentistry

The report is a review of the literature related to hepatitis B and its implications for dental practitioners. Hepatitis B represents a serious health risk among dentists and simple preventive measures can greatly reduce the risk of transmission or contraction of the disease. Certain positive findings in a healthy history should alert the dentist that he may be treating a carrier of hepatitis B. If so, the wearing of gloves, a mask and protective eyewear will almost totally protect one from contracting the disease. To guard against transmission of hepatitis B to other patients in the dental practice, all instruments should be sterilized and all environmental surfaces should be appropriately treated. A person with a confirmed exposure to hepatitis B should be inoculated with immune serum globulin.