Effect of ethanol during hepatitis B virus infection in chimpanzees

To determine whether the use of ethyl alcohol (ethanol, C2H5OH) may increase the liver damage caused by hepatitis B virus infection, ethanol was infused into four chimpanzees on one or two occasions during the course of natural or experimentally induced hepatitis B virus infections. A fifth chimpanzee, without active hepatitis B virus infection, served as a control. Moderate elevations of serum aspartate or alanine aminotransferases occurred in four of the five chimpanzees, including the control chimpanzee, in direct association with ethanol infusion; pre-existing enzyme elevations persisted in a fifth chimpanzee. No alteration occurred in the titers of hepatitis B surface antigen or of antibody to hepatitis B core antigen in three of the four infected chimpanzees. There was no significant alteration in the course of hepatitis B virus infection by ethanol infusion in these chimpanzees.

Natural history of acute hepatitis B in previously healthy patients: A prospective study

A prospective study of the natural history of acute hepatitis B was performed in 38 patients. Fatigue started median 4 weeks, abdominal symptoms median 3 weeks and signs of cholestasis median 2.5 weeks before peak SGPT values were reached. Extrahepatic manifestations occurred throughout the prodromal stage, the presence of arthropathy, urticaria or skin rashes was not related to the biochemical severity of liver disease. The higher the the maximal values of serum bilirubin and/or the older the patient, the longer the period of bilirubin elevation; a maximal bilirubin elevation less than 20 X the upper limit of normal was associated with normalisation of serum bilirubin within 6 weeks. No such correlations were found between the height of serum glutamic pyruvic transaminase, alkaline phosphatase, thymol turbidity and cholesterol levels and the subsequent duration of their abnormality. The elevation of alkaline phosphatase as well as the abdominal complaints might partly be caused by gastro-intestinal involvement. Immobilisation before peak SGPT was attained was associated with normalisation of serum glutamic pyruvic transaminase levels within 8 weeks after peak levels. 37 patients recovered completely. In one HBs-antigenemia and slight SGPT elevation persisted. Long term follow up was possible in 33 patients for 4 to 7 years, median 5 years.

Chronic active hepatitis in patients with and without hepatitis B surface antigenemia

This study was designed to compare the clinical and immunological characteristics of the hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative (cryptogenic) forms of chronic active hepatitis. The data of 48 patients with chronic active hepatitis, 24 with persistent HBs antigenemia and 24 without HBsAg, were analysed. HBsAg was detected by counter-immunoelectrophoresis and radioimmunoassay. The clinical features, biochemical liver function tests, immunoglobulins, complement C3, antoantibodies, and cell-mediated immunoreactivity of the two forms of the disease were compared. Cirrhosis was found to occur more frequently at the time of diagnosis in the HBsAg-negative group, and the serum alkaline phosphatase level was raised significantly compared to the HBsAg-positive form. The elevation of the IgG level was greater in the cryptogenic form, but the difference was not statistically significant compared to the HBsAg-positive patients. There was a marked difference in the frequency of the mitochondrial antibodies, but not of the antinuclear factor and other autoantibody-like serum factors. Lymphoblastic transformation revealed a similar diminution in response to phytohaemagglutinin stimulation in both groups of patients compared to the normal controls. An increase of the 3H-thymidine incorporation was seen after stimulation with human liver mitochondrial antigen, and leukocyte migration inhibition could be observed with this antigen in both forms of chronic active hepatitis.

The long-term outcome of hepatitis B

Among 466 hospitalized patients with serologically verified acute hepatitis B, 440 individuals (94.4%) could be followed up until normalization of liver function had occured, or for at least one year. In 90.2% of the patients followed-up liver function including galactose tolerance) returned to normal within four months after onset of illness. Chronic persistent hepatitis B surface antigen (HB Ag) for at least one year in 14 patients (50%). Liver biopsy was performed in consistent with CPH in all cases. Histological signs of chronic aggressive hepatitis developed in 15 patients (3.4%) and persistence of HB Ag was observed in 11 of these patients (73%). No histological follow-up was performed in patients with normal liver function within four months after onset of illness. Cprticosteroid treatment in 56 patients with prolonged symptoms did not seem to predispose to persistence of HbsaG in the serum.

[Physiopathology of hepatitis B virus infection]

Hepatitis B associated antigen (HB-Ag) may be observed in the serum in subjects either apparently healthy or exhibiting a number of disease symptoms. Its incidence among the Geneva voluntary blood donors is 0.48% with 54% exhibiting the surface antigen ad and 34% ay. While the HB-Ag positive blood donors appeared clinically healthy, minor pathology was found in the majority of them (thrombocytopenia, histological evidence of inflammatory foci, of persistent hepatitis and of chronic aggressive hepatitis). In 82 patients suffering from hepatitis B the same ad-ay type distribution of the HB-Ag has been found. In 11 out of 31 patients increased Clq binding suggests the presence of circulating complexes. Diminutions in the level of complement components also indicates participation of complement in the formation of immunocomplexes. In 2 out of 3 patients with Hb-Ag positive polyarteritis nodosa, the Clq binding test was also positive. The pathophysiologic implications of hepatitis B infection are discussed in connection with the authors and other findings. It appears that the main defense mechanism leading to elimination of the viruses within the hepatocytes lies in cell mediated immunity. Hepatitis would then represent the side reaction of this defense mechanism. Antibodies are probably useful in preventing the virus from entering the cell, but also in the course of the cell mediated defense mechanism (elimination of viral material liberated during the T-cell hepatocellular interaction). Immune complexes may be operative in certain extrahepatic manifestations such as arthralgia. Polyarteritis nodosa may result from local antibody interaction with antigen fixed within arterial walls.

Hepatitis

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Neuropathy associated with hepatitis in patients maintained on haemodialysis

During a study of peripheral nerve function in chronic renal failure, 11 patients who were being treated by chronic intermittent haemodialysis developed serum hepatitis. Before the infection there was a trend towards improvement in nerve conduction velocities. A pronounced deterioration in the conduction velocities in motor fibres of peripheral nerves occurred in association with hepatitis. In the months after recovery from the infection there was again a trend towards improvement in conduction velocities. We suggest that this reflects the occurrence of a peripheral neuropathy which is at least in part demyelinating. The neuropathy is related to the serum hepatitis, but its pathogenesis is indeterminate.