Hepatitis-associated antigen and antibody in Swedish blood donors. Relation to liver disease

Subtypes of Hepatitis B Antigen in Blood Donors and Post-transfusion Hepatitis: Clinical and Epidemiological Aspects

Subtyping of hepatitis B antigen (HBA) in blood donors revealed subtype ad in 56% while patients with icteric post-transfusion hepatitis from the same centre showed subtype ay in the majority of the cases (75%). Donors with subtype ad in serum were mostly asymptomatic long-term carriers of the antigen with normal liver function (83%), while 70% of donors with subtype ay in serum had signs of acute or chronic liver disease. Healthy long-term carriers of HBA seem to present little risk of transmitting hepatitis irrespective of subtype. It is, however, possible that these differences in blood donors with subtype ad and patients with post-transfusion hepatitis with subtype ay might reflect epidemiological circumstances rather than biological differences in the two viral strains.

Antibodies to hepatitic C virus and chronic liver disease among Finnish patients with haemophilia

Antibodies to hepatitis C virus, hepatitis B serology and liver enzymes were examined in 137 Finnish haemophiliac patients to detect signs of chronic viral hepatitis and its possible aetiological associations. The prevalence of raised alanine aminotransferase values was 37%. These were significantly associated with hepatitis C seropositivity but not with hepatitis B antibodies, severity of haemophilia or the type of clotting factor used in replacement therapy. The prevalence of hepatitis C seropositivity was 50%; it was significantly associated with severe haemophilia and with the use of large pool concentrates. The hepatitis C virus seems to be the major cause of chronic liver disease transmitted by clotting factors also in Finland, despite a somewhat lower seroprevalence than described elsewhere so far.

HBsAg-positive Swedish blood donors: natural history and origin of infection

99 HBsAg-positive blood donors (BDs) were discovered in Göteborg during 1970-84. Of the 82 patients where the outcome is known 46 had transient and 36 persistent antigenemia. Chronic hepatitis was found in 6 patients while 30 were asymptomatic carriers. Three BDs had died, 1 of them from cholangiocellular cancer. An obvious mode of transmission was demonstrated for 19 BDs, i.v. drug abuse being the most frequent one. Five BDs originated from countries with a known high prevalence of hepatitis B virus (HBV). Family contacts of the remaining carriers had serological markers for HBV in the following frequencies: mothers 46%, siblings 39%, fathers 25%, children 13%, spouses 10%. Only children of female carriers had markers for HBV infection. Intrafamiliar transmission during childhood is an important route of transmission even in a country with low HBV endemicity and amongst people without connection with endemic regions. This population may be susceptible to the consequences of a long-term carriership of HBV.

Determination of HBeAg by radioimmunoassay: prognostic implications in hepatitis B

A radioimmunoassay was used to determine the presence of the hepatitis B e antigen (HBeAg) and anti-HBe in the serum of 12 hepatitis B patients, who were follofed from an early phase of the illness into convalescence. The duration of detectable HBeAg in serum from these patients, in all ow whom the disease ran a normal course, was compared with the persistence of HBeAg in serum of nine patients with a protracted course and persistence of HBsAg in serum for more than 1 year. None of the hepatitis B patients with a normal course of the disease had HBeAg demonstrable for more than 9 weeks after the onset of illness (mean 5.4 weeks), whereas all patients developing chronic hepatitis had HBeAg in serum for more than 1 year after the onset of illness. These findings indicate that the detection of HBeAg in serum by radioimmunoassay for 10 weeks or more after the onset of illness implies a great risk of progression of the hepatitis B infection to chronic liver disease.

Asymptomatic structural liver disease in hemophilia

In a study of persistent abnormalities of liver-function tests in hemophilic patients deficient in factor VIII or IX and treated with factor VIII or IX concentrates, we examined 14 liver biopsies from 13 anti-HBs-positive patients. None had any symptoms of liver disease. All had chronically abnormal levels of alanine aminotransferase. Histologic studies showed chronic persistent hepatitis in eight patients, chronic active hepatitis in four and fatty infiltration with portal fibrosis in one. Indirect immunofluorescence of antiserums containing anti-HBs or anti-HBc (or both) revealed nuclear and cytoplasmic fluorescence in the hepatocytes of eight of 12 patients. Specificity testing of these antiserums confirmed that hepatitis B viral markers are present in the hepatocytes of these anti-HBs-positive patients. These histologic derangements are probably related to frequent treatment with blood products obtained from multiple donors and to the persistance of hepatitis B virus in hepatocytes despite the presence of circulating anti-HBs.

Epidemiology of hepatitis B antigen and antibody in hospital patients in Copenhagen

A 4-year continuous screening for hepatitis B antigen (HBAg) in all patients admitted to a Copenhagen general hospital revealed 253 antigen-positive cases among 99000 patients (2.5%). 97 of the patients had acute or chronic hepatitis, while there were no signs of liver disease in 156. The "healthy" carriers showed a wavy age distribution, indicating an increased transmission of HBAg in age groups born 1920-30 and 1940-60. Hepatitis B antibody (HBAb), measured by a radioimmunoassay, occurred in 8.6% of 1000 patients. HBAb also showed an uneven age distribution with a peak prevalence of 17.5% in the age group born 1910-30. These figures indicate that the prevalence of HBAg and hence presumably also the hepatitis B virus has fluctuated within this homogeneous population, probably related to changes in the sociohygienic conditions. Determination of HBAg subtypes D and Y in 161 patients indicated that the Y-subtype is now being introduced into a formerly subtype D area by means of drug addiction, tourism or workers of East-Mediterranean origin.

Familial accumulation of carriers of Au antigen

The sibs and parents of 83 Au-positive blood donors were tested in order to study the possible family clustering of Au positives in a population with a low frequency of carriers of Australia (Au) antigen. Tested by counterelectrophoresis the incidence of Au antigen in the parents of Au-positive persons is 5·4% and in the sibs 17·9%, compared to 0·15% in blood donors.

The hypothesis that the Au-carrier state is genetically determined was tested by calculating the proportion of Au-positive children in the families. The results are not inconsistent with a recessive mode of inheritance but do not allow definitive conclusions to be drawn.