Detection of hepatitis B virus DNA in asymptomatic hepatitis B surface antigen carriers: relation to sexual transmission

The authors tested, by molecular hybridization, for hepatitis B virus DNA in serum specimens of 182 asymptomatic hepatitis B surface antigen (HBsAg) Greek carriers who were heterosexual partners of patients with acute hepatitis B (group A: 96 cases) or healthy subjects who were susceptible to hepatitis B (group B: 86 cases). The mean age (34.1 +/- 10.4 vs. 33.9 +/- 8.4 years) and the mean duration of sexual contact (6.9 +/- 8.9 vs. 7.2 +/- 6.3 years) were similar in the two groups of carriers. Hepatitis B virus DNA was detected significantly more frequently in group A than in group B (59.4% vs. 11.6%, p less than 0.001). In particular, in group A, hepatitis B virus DNA was detected in 96.9% of hepatitis B e antigen (HBeAg)-positive and 41% of antibody to HBeAg (anti-HBe)-positive carriers. In contrast, in group B, hepatitis B virus DNA was identified in only 10.8% of anti-HBe-positive carriers (p less than 0.001). These differences were especially significant in the young and middle-aged carriers (16-49 years old) and during the first four years of sexual contact. These data suggest that 1) there is a positive correlation between the presence of hepatitis B virus DNA in serum and the epidemiologic evidence of sexual transmission of hepatitis B virus, 2) hepatitis B virus DNA is a better indicator of infectivity than HBeAg/anti-HBe, and 3) the detection of hepatitis B virus DNA in serum probably identified carriers with high infectivity and potentially higher risk of transmitting hepatitis B virus to their sexual partners.     

Prevalence of infection with hepatitis delta virus (HDV) among carriers of hepatitis B surface antigen in Amazonas State, Brazil

Serum samples were non-randomly obtained from apparently healthy inhabitants of 5 villages in the Amazonas State, Brazil. Sera were tested by enzyme immunoassay for the presence of hepatitis B surface antigen (HBsAg) and, if this was found, for antibody to hepatitis delta virus (HDV). Of 574 people tested, 96 (16.7%) were reactive for HBsAg and 33 of these (34.4%) for anti-HDV. The results were analysed according to sex, age and history of jaundice and showed a high prevalence of hepatitis B virus (HBV) and HDV infections in these asymptomatic persons, mainly in young people. The rates of prevalence observed in Amazonas for both HBV and HDV are perhaps among the highest in the world, demonstrating that these viruses are endemic in this region of Brazil.     

Serum alpha fetoprotein in 714 mentally retarded carriers of hepatitis B surface antigen

Sera from 714 mentally retarded carriers of hepatitis B surface antigen were screened for alpha fetoprotein (AFP) by monoclonal radioimmunoassay. Serum AFP levels were less than 20 mcg/L in 708 (99.2%) carriers. One 29-year-old carrier with normal liver function had serum AFP level of 1500 mcg/L, which increased to 12,500 mcg/L after 72 days. She died of multifocal hepatocellular carcinoma (HCC) with cirrhosis. Five other carriers with serum AFP levels between 20 and 165 mcg/L are alive without clinical HCC. No correlation was found between serum AFP level and race, age, sex, Down's syndrome, serum alanine aminotransferase level, and hepatitis B e antigen positivity. Single cross-sectional serum AFP screening by itself is not sufficient for early diagnosis of HCC.Corresponding author.Department of Pathology, University of California, Irvine, CA 92717     

An epidemiologic study of effects of alcohol in the liver in hepatitis B surface antigen carriers

A total of 932 hepatitis B surface antigen (HBsAg) carriers and 1,704 HBsAg-negative inhabitants of the Yaeyama District of Okinawa, Japan, over age 20 years were investigated in 1982-1985 in order to elucidate whether an interaction between habitual alcohol intake and hepatitis B virus infection is capable of producing liver disease. All of the subjects were tested for biochemical liver functions and asked about their habitual intake of alcohol. HBsAg carriers were tested for hepatitis B e antigen (HBeAg) and antibody to HBeAg. Subjects were ranked into three categories by alcohol consumption: nondrinkers, light drinkers (1-59 g/day), and heavy drinkers (greater than or equal to 60 g/day). The prevalence of liver abnormalities in HBsAg carriers increased with alcohol consumption. The prevalence differed significantly between nondrinkers and light drinkers in HBsAg carriers (p less than 0.001), but not in HBsAg-negative inhabitants. Prevalence also differed significantly between nondrinkers and heavy drinkers irrespective of HBsAg positivity (p less than 0.001). The highest prevalence of liver abnormalities was observed in HBeAg-positive heavy drinkers (53.8%). In conclusion, this study confirms that alcohol consumption intensifies the development of liver disease caused by hepatitis B virus. Therefore, the authors see a need to educate HBsAg carriers about the risks of consuming alcohol.     

Delta virus and hepatitis B surface antigen in chronic liver diseases.

This work was carried out on 45 patients with chronic liver diseases, including 24 cases of liver cirrhosis and 21 cases of chronic hepatitis. Their ages ranged from 2 to 15 years (median 5). All cases were examined clinically and assessed biochemically for liver function tests. Serological studies were performed to detect hepatitis B surface antigen (HBsAg) and delta IgG antibody (IgG anti-HD) using Enzyme Immunoassay (EIA) technique. The study showed that IgG anti-HD was detected in 8.9% of cases with chronic liver diseases (all positive cases were with liver cirrhosis). On the other hand, HBsAg was detected in 53.3% of cases (54.2% of them with cirrhosis and 45.8% with chronic hepatitis) with no significant association between HBsAg positivity and type of hepatic illness. Moreover, IgG anti-HD was positive in only 4.2% of HBsAg positive cases, while 14.3% of HBsAg negative cases were positive for IgG anti-HD. A significant association was also found between delta positivity and serum glutamic oxaloacetic transferase level (SGOT). We concluded that chronic delta hepatitis appeared to be more severe than other types of chronic viral hepatitis, as all delta positive cases were with liver cirrhosis and had elevated SGOT levels. Screening of delta markers in addition to hepatitis B viral markers could improve the understanding of a number of obscure cases of chronic hepatic illnesses and would help in the control of HBV and consequently HDV infection in the general population.     

血清乙型肝炎表面抗原定量在慢性乙型肝炎诊治中的临床应用和价值

HBsAg定量在慢性乙型肝炎诊治中相当重要。已有研究证明,HBsAg和HBV DNA水平的结合检测可鉴别非活动性HBV携带者。抗HBV治疗过程中,检测HBsAg定量可反映抗病毒疗效。HBAg水平快速下降可预测持续应答。此文就HBsAg定量在慢性乙型肝炎诊治中的临床应用和价值进行了综述。     

Province of origin of hepatitis B surface antigen carriers among blood donors in Port Moresby

A paper published in the Medical Journal of Australia in 1972 gave a breakdown of Port Moresby blood donors by HBS Ag carrier status and area of origin. It has lately become possible to test whether such geographical subsamples provide reliable evidence of the carrier status in the home areas, and it appears that, except for the Islands provinces, they do not. Traditional lifestyles conduce to the maintenance and spread of the virus, which is much more prevalent in the provinces than in the capital.     

工矿企业成人HBsAg慢性携带者生活质量评价

目的了解HBsAg慢性携带者生活质量的现状。方法以某集团公司现有在岗5 a以上的职工中的HBsAg慢性携带者104人为研究组,并随机抽取与其具有可比性的正常人群105人为对照组,采用《生活质量综合评定问卷(GQOL-74)》和《健康状况调查问卷(SF-36中文版)》等进行生活质量的调查,分析慢性HBsAg携带者生活质量的现状。结果HBsAg慢性携带者GQOL-74总分为59.88±9.82,低于正常人得分66.73±7.86;SF-36总分为73.95±10.46,亦低于正常人得分81.88±8.22。结论慢性HBsAg携带者的生活质量因HBsAg的感染而受到了影响。     

慢性乙型肝炎患者血清表面抗原与抗体同时阳性结果分析

目的:探讨乙型肝炎患者HBsAg和抗HBs共存模式及与HBV DNA的关系。方法:采用增强化学发光法检测血清乙肝标志物,并采用荧光定量PCR法检测HBV DNA。结果:5717例慢性乙肝患者检测出HBsAg和抗HBs双阳性248例,占4.34%,其中多数与HBV DNA同时出现。结论:HBsAg和抗HBs同时阳性并不少见,慢性乙肝患者出现抗HBs,不完全代表病毒复制终止,需结合HBV DNA定量综合分析。     

Hepatitis B immunisation rates among infants in ethnic groups with high prevalences of hepatitis B surface antigen carriers

Abstract: To determine hepatitis B immunisation rates in infants from ethnic groups with hepatitis B surface antigen chronic carrier prevalence over 5 per cent, a questionnaire was sent to all Maternal and Child Health Centres in Victoria, requesting information on the hepatitis B and diphtheria–tetanus–pertussis (DTP) or combined diphtheria–tetanus (CDT) immunisation status for all infants born between 1 July 1992 and 30 June 1993 and at risk of hepatitis B infection because of maternal ethnicity. We received data on 3611 of 5744 infants (62.9 per cent) in targeted ethnic groups. Of these, 12.8 per cent had not received hepatitis B vaccine, and 81.6 per cent, 76.8 per cent and 64.0 per cent had received at least one, two and three doses respectively, while 84 per cent had received at least three doses of DTP vaccine and/or CDT vaccine. Coverage with DTP or CDT was higher than for hepatitis B vaccine ( P < 0.001), and coverage was better in areas with a higher percentage of infants in high–prevalence ethnic groups ( P < 0.001). Changes in the program in Victoria in terms of timing of the first dose of vaccine plus greater attention to follow–up may lead to improved hepatitis B immunisation rates among infants in targeted ethnic groups. Adoption of universal infant hepatitis B immunisation, by increasing familiarity with hepatitis B vaccine, is likely to be the best way to increase immunisation coverage for these infants.     

Sero-epidemiology and risk factors of positive hepatitis B surface antigen amongst Chinese adolescents

This paper reports the prevalence rate of hepatitis B antigen (HBsAg) amongst the Hong Kong Chinese adolescents (age 11 to 19), and the risk factors associated with HBsAg positive. The study is cross sectional and 1,580 students were randomly selected from 12 secondary schools in four regions of Hong Kong. For those subjects who agreed to participate and were randomly selected, their blood was tested for HBsAg and anti-HBs. The overall prevalence of HBsAg positive was reported to be 5.8% (7.9% in male and 4.1% in female), lower than 8.1% in 1978. Males, those born in Mainland China and family history of carriers had higher prevalence of HBsAg positive (7.9% vs 4.1%, 12.2% vs 4.7%, 52.9% vs 3.8% respectively) with statistical significance. Males and those born in mainland China were found to have significantly higher odds ratio 1.8 (95% CI. 0.98-3.52) and 4.4 (95% CI. 2.2-8.8) respectively of HBsAg positive by multivariate analysis. Findings suggest that family history of carriers and those born in endemic area are at a higher risk. Therefore it is worthwhile to consider vaccination programme for adolescents to reduce the carrier rate, and to also reduce the injection amongst the adults by horizontal transmission.     

“a”决定簇变异对慢性乙型肝炎患者HBsAg与HBsAb表达的影响

目的研究＂a＂决定簇变异对慢性乙型肝炎患者乙型肝炎表面抗原（HBsAg）与表面抗体（HBsAb）表达的影响。方法收集HBsAg阳性持续6个月以上的CHB患者866例，其中789例（91．1％）仅HBsAg阳性，77例（8．9％）患者血清HBsAg与HB-sAb均阳性。从77例血清HBsAg与HBsAb双阳患者中，选择14例血清HBsAg与HBsAb双阳患者为Ⅰ组。789例HBsAg阳性患者中随机选择12例HBsAg单独阳患者为Ⅱ组对照。对HBsAg编码基因进行扩增和克隆，每例样本至少克隆15个后进行测序分析。结果Ⅰ组患者S蛋白氨基酸残基改变数量为Ⅱ组患者的2．7倍[9．52变化量／100残基vs2．43变化量／100残基（9．52％VS2．43％），P〈0．01]，且绝大多数发生在主亲水区（MHR）“a”决定簇。MHR区至少出现2残基改变的在Ⅰ组有10例（71％），Ⅱ组3例（25％）。Ⅰ组患者S蛋白残基改变常见位点为s145、s129、s126、s144和s123。这些S基因位点突变，最终形成病毒的免疫逃逸。结论CHB患者HBsAg和HBsAb共存可能与“a”决定簇变异率升高相关。“a”决定簇变异可能为乙型肝炎病毒免疫逃逸突变的一种选择。HBV免疫逃逸对疫苗接种免疫效应、临床疾病诊断和治疗策略革新等有影响。     

Subtypes of hepatitis B antigen among patients and symptomless carriers.

A study of the distribution of subtypes ad and ay among sera from hepatitis B antigen-positive subjects in North West England and North Wales revealed a marked contrast between symptomless carriers among whom ad predominated and patients with acute hepatitis the majority of whom were ay. Those with hepatitis associated with drug addiction or other forms of "needle transmission" were almost all of subtype ay. On the other hand in cases of "sporadic" hepatitis without evidence of parenteral exposure subtypes ad and ay are about equally distributed. These findings are similar to those reported from other countries in Northern Europe and North America. Although geographical and social factors clearly affect the distribution of the two subtypes it is suggested that the virus of subtype ay may be more readily transmitted than subtype ad by parenteral routes involving small amounts of blood.     

Time trends of the prevalences of hepatitis B e antigen positives among hepatitis B virus carriers in Japan

In order to examine time trends of the prevalences of HBeAg positives among HBV carriers in Japan, we analysed data on HBeAg of HBsAg positive voluntary blood donors (23,560 males, and 8659 females) at the Osaka Red Cross Blood Centre between January 1977 and March 1984. Age-specific prevalences of HBeAg positives decreased year by year for both sexes, especially for those in their teens and twenties. The prevalences of HBeAg positives decreased with age, but at any given age it was lower for the later than for the earlier birth cohorts. Although reasons for the secular declines are unknown, the findings suggest that the prevalence of HBeAg positives among HBV carriers will continue to decrease in Japan. This, together with the immunization programme implemented this year, may lead to a future reduction in the risk of HBV related liver diseases in Japan.     

乙型肝炎病毒表面抗原在慢性乙型肝炎病毒感染后不同临床阶段的定量检测及临床意义

目的 测定慢性乙型肝炎病毒（HBV）感染后不同临床阶段患者血清乙型肝炎病毒表面抗原（HBsAg）定量,同时探究其与患者血清HBV DNA水平和年龄的相关性.方法 将未经抗病毒治疗的774例慢性HBV感染患者按照临床特征分为六组：慢性HBV携带组（102例）、非活动性HBsAg携带组（211例）、乙型肝炎病毒e抗原（HBeAg）阳性慢性乙型肝炎组（236例）、HBeAg阴性慢性乙型肝炎组（114例）、HBeAg阳性乙型肝炎肝硬化组（52例）、HBeAg阴性乙型肝炎肝硬化组（59例）,采用化学发光微粒子免疫分析法测定患者血清HBsAg定量,实时荧光定量聚合酶链反应法测定患者血清中HBV DNA定量,血清HBsAg和HBV DNA需要经常用对数转换后进行组间比较.结果 HBsAg定量由高到低分别为慢性HBV携带组、HBeAg阳性慢性乙型肝炎组、HBeAg阴性慢性乙型肝炎组、非活动性HBsAg携带组、HBeAg阴性乙型肝炎肝硬化组和HBeAg阳性乙型肝炎肝硬化组[7.80（6.69 ～ 8.32）、7.11（5.42～8.27）、6.57（5.66 ～ 7.53）、6.38（4.39～ 7.40）、6.22（4.84～ 6.91）、6.13 （5.48～7.01）].HBeAg阳性慢性乙型肝炎组和HBeAg阴性慢性乙型肝炎组HBsAg定量与HBV DNA呈正相关（r=0.714和0.390,P＜0.01）.慢性HBV感染患者血清HBsAg的定量与年龄呈负相关（r=-0.416,P＜0.01）;监测年龄≥40岁非活动性HBsAg携带者的血清HBsAg定量有重要的临床价值.结论 慢性HBV感染后不同临床阶段患者血清HBsAg定量不同,血清HBsAg定量与患者HBV DNA水平和年龄相关,临床上应重点监测年龄≥40岁非活动性HBsAg携带患者血清HBsAg定量.     

Antibodies to delta antigen in asymptomatic hepatitis B surface antigen-reactive blood donors in the United States and their association with other markers of hepatitis B virus

A total of 1,915 sera collected in 1979 from asymptomatic hepatitis B surface antigen (HBsAg) carriers were tested for delta antigen, antibody to delta antigen (anti-delta), hepatitis B e antigen (HBeAg) and antibody to hepatitis B e antigen (anti-HBe) in addition to HBsAg and its subtypes. These sera represented blood donated by volunteers to 49 of 57 regions of the American Red Cross located in nine geographic regions of the United States and Puerto Rico. A total of 72 (3.8%) sera had anti-delta activity while none had a detectable level of delta antigen. A significantly higher (p less than 0.01) prevalence of anti-delta (12.1%) was found in San Jose, California (Pacific Region); on the other hand, the East South Central region covering Alabama, Kentucky, Mississippi and Tennessee had a significantly lower (p less than 0.05) prevalence (1.4%) of anti-delta when compared with all other regions combined. Anti-delta was, however, detected in all regions of the United States and in Puerto Rico. The cause of significant differences in the prevalence of anti-delta was not clear. The distribution of anti-delta was not associated with age, sex or blood type of the donor. Sixty-nine of 70 samples with anti-delta were found among the 1,527 samples that had either HBeAg or anti-HBe. And among 149 that lacked both HBeAg and anti-HBe, only one sample had anti-delta. The difference is statistically significant (p less than 0.05). The presence of anti-delta was not associated with HBsAg/ad (2.7%) or HBsAg/ay (4.6%).     

IgM-antibody response to the hepatitis B core antigen in acute and chronic hepatitis B.

A solid phase M-antibody capture radioimmunoassay (MACRIA) and a serum fractionation method were used to quantitate the IgM response to the hepatitis B core antigen (IgM anti-HBc) in acute and chronic hepatitis B infections. Antibody to the core antigen was predominantly of the IgM class during the acute phase of hepatitis B. Resolving acute infections remained positive by MACRIA, but at decreasing levels, for as long as 6 months. IgM anti-HBc persisted in HBsAg carriers but at levels very much lower than seen in acute infections. There was no correlation of IgM anti-HBc with severity of chronic liver disease in carriers. Measurement of IgM anti-HBc by MACRIA enabled accurate identification of acute hepatitis B on single serum specimens.     

慢性乙型肝炎病毒携带者的肝组织病理分析

目的对178例年龄在12～40岁之间的慢性HBV携带者与非活动性HBsAg携带者肝组织病理结果进行分析。方法178例分为<20岁、<30岁、<40岁三个年龄组,分别观察三个年龄组间肝组织炎症活动度及纤维增生的分布情况及差异性。结果>G2/S2的分布为<20岁年龄组(14%),<30岁年龄组(41%),<40岁年龄组(80%)。随年龄增长,肝组织损伤的程度呈加重趋势,差异有显著性(P<0.05)。不同年龄与病毒基因水平,肝组织病变程度与病毒基因水平之间差异无显著性(P>0.05)。慢性HBV携带者与非活动性HBsAg携带者之间肝组织病变差异有显著性(P<0.05)。结论对上述两种携带者,有条件时最好行肝活检,以早期发现适宜治疗者而避免延误病情。对两者间的治疗应有所侧重。