[Prognostic value of alpha-foetoprotein in fulminant hepatitis (author's transl)]

Serum concentrations of alpha-foetoprotein (AFP) were measured sequentially by radioimmunoassay in 32 patients with fulminant hepatitis and coma, 22 of whom died. Levels were significantly elevated in 100% of patients who survived and in 7 out of 22 patients (38.5%) who died (P = less than 0.005). In the survivors the rise of AFP levels was found early after the development of coma and subsequently in all serum samples obtained during acute phase of illness. In 2 of 7 fatal cases who had raised AFP levels and the more protracted illness, AFP levels fall after 6 days. The high levels of serum AFP observed in severe forms of hepatitis may represent active hepatocyte regeneration after extensive hepatic necrosis. Although the correlation between survival and serum concentration of AFP is not absolute, our finding indicate that the rise in serum of this protein in patients with massive hepatic necrosis may be considered a favorable prognostic sign.

Persistence of e antigen as prognostic marker in acute hepatitis B

Serial determinations of HBeAg and anti-HBe were made in sera of 155 selected patients with acute hepatitis B who were followed up for one to four years. In the early phase of hepatitis, HBeAg was present in 43 cases (27.7%) and anti-HBe in 12 cases (7.7%). Evaluation of the outcome of hepatitis showed that development of chronic hepatitis occurred in 11 out of 43 HBeAg positive patients, in 10 out of 100 HBeAg negative patients (P = less than 0.05) and in 2 out of 12 patients carrying anti-HBe. Nine out of 11 HBeAg positive chronic subjects showed persistent HBe antigenemia over two months, while the remaining 32 patients, who recovered completely, lost HBeAg within two to three weeks from the onset of the disease. These data suggest that the prognostic value of HBeAg in acute hepatitis patients may be taken into account when HBeAg persists in the serum and that anti-HBe does not invariably protect from the development of chronic hepatitis.

[Factors of contagiousness in the epidemiology of hepatitis type B (author's transl)]

Since morbidity of viral hepatitis B is increasing, the causes of diffusion of this infection have been studied. There are several routes of transmission and undoubtedly apparent non-parenteral routes have a great importance. In a study performed on 32 families of HBsAg carriers, familial aggregation of infection has been acquired through close personal contact. Transmission of infection from mother to infant may occur transplacentally for vertical transmission, or, after the birth, for horizontal transmission, so that a high percentage of children is infected. Percutaneous transmission of hepatitis B in families affected by scabies is evident. The presence of infectivity markers is of major importance for transmission of virus: these are HBeAg and specific DNA-polymerase activity of serum. Well, when the carrier exhibits the markers, the contacts are involved in the infection in a high percentage. From this point of view the carriers with chronic liver disease are more dangerous than the asymptomatic ones. The problem of carrier exists: nevertheless it is possible to carry out a better prophylaxis, if we take into account the presence of the infectivity markers.

[Role of chronic HBsAg carriers in intrafamilial diffusion of hepatitis B virus infection]

To assess the hepatitis B virus infection risk to household contacts exposed to HBsAg-positive chronic carriers, 169 family members of 20 healthy carriers of HBsAg and of 12 with chronic hepatitis were followed up prospectively for two to five years. All family members are investigated for the presence of serum HBsAg/antiHBs system and for the presence of liver disease. Our results indicate that the family contacts of HBsAg carriers with evidence of chronic liver disease are at greater risk of exposure to HBV than the contacts of healthy carriers and that acquisition of HBsAg is more common among males than among females. Evidence of exposure to HBsAg is very frequent in young age with a striking rise between 10 and 20 years. On the contrary acquisition of anti-HBsAg is more common after 40 years of age. These data suggest that persistent circulation of HBV in a family of chronic HBsAg carrier increases the risk of infection in household contacts and that HBV is eliminated in a more infective form from the carriers with chronic liver disease.

[Epidemiologic study of chronic hepatitis in relation to heptatis B virus infections (author's transl)]

In order to evaluate the role of hepatitis B virus (HBV) in the etiology of chronic liver diseases, paired sera of 143 patients with biopsy-documented chronic hepatitis were tested for HBsAg and anti-HBs by radioimmunoassay method. HBsAg was detected in 67.3% of patients with a preceding verified eipsode of acute hepatitis, and in 26.7% of patients with a cryptogenic form of chronic hepatitis. HBsAg was not found in any of patients with alcoholic chronic hepatitis and in only two of 18 patients with other forms of chronic liver disease. No significant difference in the incidence of anti-HBs was observed in all groups of patients. According to previous studies our results confirm the higher prevalence of HBV infection in etiology of chronic persistent and aggressive hepatitis and indicate that this prevalence may be observed especially in Middle and South Italy. The presence of HBsAg in the serum of 37.2% of our patients with cirrhosis compared with 9% of reported cases in North Italy suggest that HBV plays an important role in the etiology of cirrhosis of the liver in our area.

[Behavior and clinical significance of the eAg/ anti-e system in carriers of HBsAg]

An investigation has been carried out in 315 patients with acute and chronic HBsAg positive and negative hepatitis in order to study the relationship between a new recently identified antigen/antibody system designed eAg/anti-e and HBV pathology. eAg was detected in sera of 37,8% patients with acute hepatitis who recovered normally and of 65% patients with acute protracted hepatitis and circulating HBSAg. eAg was not found in the serum of any of 52 cases of acute HBsAg negative hepatitis. Prevalence of eAg positivity was also demonstrated especially in patients with more severe forms of chronic hepatitis. Anti-e was not found in any of 20 patients with acute protracted hepatitis, but in 40% of subjects with acute hepatitis who recovered, in 54,5% of asymptomatic HBsAg carriers and in 30% of patients with chronic persistent hepatitis. Our results confirm the specific association between eAg/anti-e system and hepatitis B infection and indicate that eAg determinant is associated with continuing activity and chronicity of hepatitic process. In contrast, anti-e is correlated with normal recovery of acute hepatitis, but it may be indicative also of asymptomatic carriage of HBsAg and of non-progressive liver disease.