e-antigen and age in acute and chronic type B hepatitis

The influence of e-antigen upon the course and outcome of acute type B hepatitis was studied in a series of 202 patients. Of these, 54 (27%) had e-Ag, detected in the serum at the same time as HB_sAg during the incubation period or at onset. In 39 patients (73%) the e-Ag disappeared within eight weeks after onset, regularly followed by clearance of HB_sAg approximately four weeks later; anti-HB_s was detected shortly thereafter in 34 cases. In 15 (28%) of e-Ag-positive and in 4 (3%) of e-Ag-negative patients, HB_sAg persisted for one year or longer; chronic hepatitis developed in 13 of these cases, 12 of which were e-Ag-positive. Among e-Ag-positives HB_sAg persisted only in those cases in which the e-Ag also persisted; all these were persons under 15 years of age. Transaminase and bilirubin values were equally high in e-Ag-positive and e-Ag-negative patients with resolving hepatitis, but were low from the start in those who later developed chronic liver conditions, irrespective of the presence or absence of e-Ag. It is concluded that in e-Ag-positive acute type B hepatitis patients the disappearance of this antigen from the serum is a good prognostic sign, whereas its persistence beyond eight weeks, especially in young children with low transaminase and bilirubin response, signals evolution towards chronicity.