Serological evidence of hepatitis B infection in patients with chronic liver diseases: radioimmunoassay of HBsAg and anti-HBs

Inhibition ELISA for hepatitis B surface antigen (HBsAg) using monoclonal idiotype-anti-idiotype interaction

Monoclonal anti-idiotypic antibody (Anti-Id) to the common (a) epitope of hepatitis B surface antigen (HBsAg) were raised and used to detect serum HBsAg in an inhibition enzyme-linked immunosorbent assay (inhibition ELISA). HRP-labelled Id 8D-3-6 was reacted with Anti-Id 4-8H coated on the solid phase in the presence of HBsAg. The ability of the antigen to inhibit the binding of labelled Id 8D-3-6 to anti-Id 4-8H was determined and the results correlated well with those obtained by radioimmunoassay. This assay requires only one washing step, takes 2 h and covers the range 10 ng/ml to 1 microgram HBsAg/ml. The inhibition ELISA is a more convenient, rapid and relatively sensitive assay which can be used to measure the level of a wide range of serum HBsAg.

Studies on the pathogenesis of hepatocellular carcinoma in HBV-negative alcoholic cirrhotics

Ninety five cases of HBV marker-negative cirrhosis with excess alcohol intake were examined clinicopathologically to obtain some clues and insights into the pathogenesis of hepatocellular carcinoma (HCC). The following data were obtained: cases were divided morphologically into 37 cases of macronodular cirrhosis (MacCir), 16 mixed cirrhosis (MixCir), and 42 micronodular cirrhosis (MicCir), the mean age at death was the oldest in MacCir (61 yrs), the youngest in MicCir (51 yrs), and intermediate in MixCir (59 yrs), association of HCC was common both in MacCir and MixCir (78 and 63%, respectively) but infrequent in MicCir (17%), all livers of MicCir with HCC had broad collapse and a small number of macronodules in non-cancerous areas and the mean age of them was older than that of MicCir without both the collapse and macronodules (56 vs 48 yrs), in total cases, the mean age at death of patients with HCC was 7 years older than that without HCC (60 vs 53 yrs), the mean liver weight was the largest in MicCir (1,211 g), the smallest in MacCir (829 g), and intermediate in MixCir (1,022 g), the incidence of MacCir was significantly higher in patients who had given up alcohol for more than one year before death than those without abstinence, and neither the subtypes of cirrhosis nor the incidence of HCC was significantly related to the total amount of alcohol intake. These data indicate that the development of HCC in HBV-negative alcoholics with cirrhosis occurs in relation to the development of macronodules and loss of liver weight, most likely along with the prolongation of the life span.

HBsAg clearance in chronic active hepatitis B. A possible cause of cryptogenic cirrhosis

Three patients with chronic hepatitis B infection, two with chronic active hepatitis and cirrhosis, and the third with quiescent cirrhosis, cleared HBsAg from their serum and eventually developed anti-HBs. All three were asymptomatic and had nearly normal serum aminotransferases following loss of HBsAg. Liver biopsy revealed cirrhosis in each patient. With the development of anti-HBs, these patients became serologically indistinguishable from patients with a cryptogenic cirrhosis who had prior unrelated exposure to hepatitis B. Remote chronic hepatitis B infection may be a more common cause of cryptogenic cirrhosis than is commonly appreciated.

Does a portal-systemic shunt increase the risk of primary hepatic carcinoma in cirrhosis of the liver?

To test the relative risk (RR) of primary hepatic carcinoma (PHC) in portal-systemic-shunted patients with cirrhosis of the liver, two autopsy materials were studied, 201 shunted and 378 non-shunted patients with histologically verified cirrhosis. Of these 579 patients, 55 had PHC (cases) and 524 were without PHC (controls). Cases and controls were divided into subgroups in accordance with sex, age, and alcohol consumption habits. Shunted patients with a postoperative survival of more than 6 months were studied separately. For shunted men alive more than 6 months postoperatively, after adjustment for difference in age and presence of large alcohol consumption, a high risk of PHC was found (RR, 3.28; 95% confidence intervals, 1.52-7.45). The presence of HBsAg was probably without importance for the relative risk of PHC in these patients, since liver tissue HBsAg was only found in 2 of all 19 shunted patients with PHC.

Hepatitis B virus infection in patients with rheumatic diseases

Two hundred and thirty-nine patients with different rheumatic diseases were investigated for serological markers of hepatitis B virus (HBV) infection. An increased prevalence of anti-HBs was found in patients with systemic lupus erythematosus. The total prevalence of HBV markers in patients with polymyalgia rheumatica, temporal arteritis, juvenile and adult rheumatoid arthritis (RA) and systemic sclerosis was not significantly different from age-matched controls. Remarkably, 6 patients were HBsAg-positive of whom 3 had RA (4%). Two patients with RA were "healthy' HBsAg carriers. The third patient had circulating HBeAg as well and had shown progression from acute hepatitis to cirrhosis during the time of observation. Three of 18 patients with polyarteritis nodosa were HBsAg- and HBeAg-positive, and all 3 were young men. Clinical improvement was seen in one of these patients and was associated with seroconversion from HBeAg to anti-HBe. Our data do not support the theory that HBV is an aetiological factor in rheumatic diseases except in some cases of polyarteritis nodosa.

Hepatitis B virus (HBV) markers among patients with chronic liver disease in Kuwait

The prevalence of hepatitis B surface antigen (HBsAg), antibody to the hepatitis B core (anti-HBc) and to surface antigen (anti-HBs), was investigated, using sensitive radioimmunoassay (RIA) systems, among patients with different clinical entities of chronic liver disease in Kuwait, and compared to a control blood donor population. 81% of patients and 44% of the controls had at lease one HBV marker. 24% of patients, but non of the controls had both HBsAg and a high titre of anti-HBc in the absence of anti-HBs, suggesting a chronic infection. 31% of our patients with hepatosplenic schistosomiasis, 20% with cryptogenic cirrhosis and chronic active liver disease and 60% with hepatocellular carcinoma had these two markers. HBV antigenaemia was significantly more prevalent among male than among female patients and was particularly high among those less than 35 years old. The high prevalence of the various HBV markers among our patients suggests that HBV is a major factor in the development of chronic liver disease in our area. Furthermore, in view of a high prevalence of antigenaemia in patients with hepato-splenic schistosomiasis, HBV infection must play a concomitant role in the development of more serious form of chronic liver disease among such patients.

Clinicopathological studies of liver cirrhosis and hepatocellular carcinoma in a general hospital

Clinicopathological studies of 181 patients with liver cirrhosis undergoing autopsy in the pathology department of a municipal hospital between 1973 and 1976 are reported. The main etiological types were alcoholic (25.4 per cent), HBsAg positive (14.9 per cent), and cryptogenic cirrhosis (54.7 per cent). Four patients had multifactorial and secondary biliary cirrhosis and one patient had congestive cirrhosis. The morphological characteristics of the condition and the age and sex distribution of the patients were analyzed in each etiological group. Hepatocellular carcinoma occurred in 28.7 per cent of the cases, most frequently in association with HBsAg positive cirrhosis. Hepatocellular atypia was significantly more frequent in HBsAg positive than in other etiological types of cirrhosis and significantly more frequent in cases associated with hepatocellular carcinoma than in those not associated with it.

Infectious liver diseases in three groups of Copenhagen workers: correlation of hepatitis A infection to sewage exposure

Three groups of Copenhagen municipality male employees-77 sewer workers, 81 gardeners, and 79 clerks-matched for age and duration of employment, were studied for clinical and serological evidence of infection with viral hepatitis types A and B and pathogenic leptospires. "Antibody against hepatitis A virus" (anti-HAV) was found significantly more often among sewer workers (80.5%), than among gardeners (60.5%) or clerks (48.1%). The anti-HAV prevalence rates correlated with age rather than duration of employment. Of all the 11 cases of jaundice reported, only 3 cases (sewer workers) occurred while employed for the city. One case of the 11 resulted from leptospirosis. Anti-HAV was detected in the other 10 subjects and was assumed to be of etiological importance. Hepatitis B serological markers were similar in each group. It is concluded that exposure to metropolitan sewage provides a limited risk of enteric infections, such as hepatitis A, while the hepatitis B virus apparently is not successfully transmitted by this route.

Changing mortality from cirrhosis in Denmark 1965-1978

The annual consumption of alcohol in Denmark doubled from 6 to 121 per adult inhabitant during the years 1964 to 1976. The impact of this change on the mortality from cirrhosis was studied. Overall cirrhosis mortality increased by 33% during this period. However, when analysed according to sex- and age-specific mortality rates, a threefold increase in mortality among young and middle-aged men was found, whereas the mortality among older women fell to 50% of previous rates. Long-term observation of female mortality demonstrated several significant changes since 1945, the reason for which could not be elucidated. Thus in Denmark mortality from cirrhosis in young men closely paralleled alcohol consumption, whereas in women other factors appeared more important and should be specifically looked for.

Hepatitis B virus and polymyalgia rheumatica: a search for HBsAg, HBsAb, HBcAb, HBeAg, and HBeAb

Forty-three consecutive patients with polymyalgia rheumatica were studied for serological markers of actual or previous hepatitis B virus infection. Signs of active virus replication, which include HBsAg supported by the presence of HBeAg and anti-HBc in high titres, were not found in any cases. Anti-HBs, a serological sign of previous hepatitis B virus exposure, was present in 16.8%. The prevalence of anti-HBs is strongly age-dependent in the normal population, and its prevalence in polymyalgia rheumatica was not significantly different from the incidence found in other hospital patients. No significantly raised incidence was found in any subgroups, including patients without liver dysfunction. These results do not support the concept that current or previous hepatitis B virus infection plays any role in the pathogenesis of the majority of cases of polymyalgia rheumatica.

Serological diagnosis of acute hepatitis B infection

The value of different serological assays of hepatitis B virus associated antigens and antibodies was tested in forty-eight consecutive cases of acute hepatitis negative for HBsAg by agargel diffusion. The tests included radioimmunoassay of HBsAg, IgM and IgG anti-HBs and counter-immunoelectrophoresis for anti-HBc detection. Twelve cases were identified as hepatitis B (25%). Eleven cases were positive for HBsAg by RIA, and only one case was detected by an increasing titre of antibodies alone. Further seventeen patients had an unchanged antibody titre to one or more antigens. It is concluded that a sensitive test for HBsAg is the most important tool for diagnosing acute hepatitis B infection.

Rapid detection of hepatitis B surface antigen by double antibody radioimmunoassay

HBsAg and anti-HBs can be detected by double-antibody radioimmunoassay in a reliable routine overnight assay of sensitivity approaching that of solid-phase immunoradiometric assay. The test requires careful standardisation and regular preparation of I125-HBsAg of appropriate quality, but otherwise uses only small quantities of commercially available reagents. In this paper, the reaction kinetics of the first incubation (test sample + limiting amount of rabbit anti-HBs), second incubation (reaction mixture + I125 -HBsAg) and precipitation reaction (reaction mixture + antirabbit globulin) were examined, to determine the minimum time required for the assay compatible with adequate sensitivity and user convenience; in addition, in order to reduce the time of radioactive counting, the maximum amount of I125-HBsAg per test compatible with a satisfactory assay was examined. It was concluded that, by terminating each reaction before equilibrium was reached, results could be obtained in 2--3 hours with a detection limit similar to the standard overnight procedure. To allow routine examination of large numbers of samples, the possibilities of complete automation of this liquid-phase type of assay were discussed.