Hepatitis B antigen and antibody in active chronic hepatitis and other liver diseases in Australia. A multicenter collaborative study

Azathioprine versus prednisone in non-alcoholic chronic liver disease (CLD). Relation to a serological classification

One hundred and forty-eight patients with non-alcoholic cirrhosis or chronic aggressive hepatitis entered a prospective, unblinded, randomized trial on the effect of azathioprine versus prednisone. For all 148 patients, there were no differences in survival related to the two drugs. In 99 patients the disease was classified as autoimmune, in 23 as posthepatitic, and in 26 as cryptogenic. No significant differences were seen in survival between these three groups of patients and no differences in survival related to the two drugs were registered within any of the groups. The autoimmune group included the patients with the biochemically most active disease, and a statistically significant reduction in activity was obtained with prednisone as well as azathioprine. Most remarkably, the frequencies of the autoantibodies were reduced parallel to the biochemical improvement in these patients. Immunosuppressive treatment was found to be rather ineffective in posthepatic chronic liver disease of type B; however, no signs of activation of the hepatitis B virus were seen.

Emerging patterns of hepatitis B chronic liver disease in Australia

Until now, the hepatitis B virus has been thought to play a minor role in the aetiology of chronic liver disease in Australia. This is a report of 21 patients with cirrhosis and/or primary hepatocellular carcinoma with hepatitis B antigenaemia. Primary hepatocellular carcinoma occurred in six patients, five of whom had underlying cirrhosis. The disease occurred mainly in non-Australian born males, and was not often associated with a previous history of hepatitis. The death of 16 patients within 12 months of presentation is in contrast to previous concepts of the benign nature of hepatitis B associated cirrhosis.

Primary hepatocellular carcinoma in Australia: Aetiological considerations

This is a study of aetiological associations in patients with primary hepatocellular carcinoma (PHC). Thirty new patients with PHC were seen in a five-year period. The most common aetiological association was alcoholic cirrhosis. This was implicated in the development of PHC in 13 patients. However, since the introduction of radioimmunoassay for hepatitis B surface antigen (HBsAg) there have been six patients with HBsAg-associated PHC. Thus, for the first time, an association of hepatitis B virus with PHC is described in this country.

The role of the hepatitis B virus infection in patients with chronic hepatitis in Argentina

Over a seven-year period, we monitored 221 patients with chronic hepatitis from two medical centers. By using the counterlectrophoresis (CEP) test to detect the presence of HBsAg and anti-HBc, or both, we established that 87.7% of them had hepatitis B infection. Serum specimens originally found negative for HBsAg by CEP were further tested by reversed passive hemagglutination (RPH), and those originally found negative for anti-HBc by CEP were further tested by radioimmunoassay (RIA). Five patients were anti-HBc-positive and HBs-Ag-negative. No sex predominance was observed, but HBsAg incidence increased with increasing age. The HBeAg antigen was detected in 46.8% of the 161 cases tested for it; the most frequent subtype found was adw (63.7%). The present findings indicate that HBV infection largely contributes to the development of chronic hepatitis in Argentinian patients.

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.