LETTER
Prognosis of Asymptomatic Hepatitis B Surface Antigen Carriers
Kendo Kiyosawa;
Takeshi Sodeyama; and
Eiji Tananka
15 September 1993 | Volume 119 Issue 6 | Page 535
TO THE EDITOR:
de Franchis and colleagues [1] reported that Italian hepatitis B surface antigen (HBsAg) carriers with initially normal liver function test results have an excellent prognosis and a low risk for developing hepatocellular carcinoma. This differs in Japan. In adult Japanese HBsAg asymptomatic carriers with normal liver function test results and normal liver histology, 40% are hepatitis B e antigen (HBeAg)-positive carriers and 60% are anti-HBe-positive carriers [2]. The prognosis of HBeAg-positive asymptomatic HBsAg carriers appears to be poor. Of 32 HBeAg-positive carriers followed for an average of 13 years (range, 8 to 20 years), 16 (50%) developed hepatitis caused by hepatitis B virus infection; this was determined by IgM anti-hepatitis B core antigen positivity, anti-hepatitis D virus negativity, anti-hepatitis C virus (HCV) negativity, antinuclear antibody negativity, and no history of alcohol abuse. The remaining 16 carriers had normal liver function test results. Of the 16 patients who had hepatitis, 7 became anti-HBe-positive asymptomatic carriers and 9 had persistent HBeAg. Six patients had chronic active hepatitis, 2 had liver cirrhosis, and 1 had hepatocellular carcinoma. Conversely, 50 anti-HBe-positive asymptomatic HBsAg carriers followed for an average of 14 years (range, 8 to 18 years) had normal liver function test results and anti-HBe. No patient lost HBeAg. Although HCV infection is the major cause of hepatocellular carcinoma in Japan [3], HBV infection also appears to be important here.
1. de Franchis R, Meucci G, Vecchi M, Tatarella M, Colombo M, Del Ninno E, et al. The natural history of asymptomatic hepatitis B surface antigen carriers. Ann Intern Med. 1993; 118:191-4.
2. Kiyosawa K, Yamamura N, Sodeyama T, Yoda H, Imai Y, Imai H, et al. Intrahepatic expression of HBsAg and HBcAg in asymptomatic HBsAg carriers and its follow-up. J Gastroenterol Hepatol. 1988; 3: 19-27.
3. Kiyosawa K, Furuta S. Clinical aspect and epidemiology of hepatitis B and C viruses in hepatocellular carcinoma in Japan. Cancer Chemother Pharmacol. 1992; 31(Suppl):S150-6.
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