REPLY
Prognosis of Asymptomatic Hepatitis B Surface Antigen Carriers
Roberto de Franchis;
Gianmichele Meucci; and
Maurizio Vecchi
15 September 1993 | Volume 119 Issue 6 | Page 535
IN RESPONSE:
We believe Dr. Kiyosawa and colleagues are correct that the main difference is the prevalence of HBeAg. This may account for the high morbidity and mortality rates found in Japanese HBsAg carriers who have initially normal liver function tests when evaluated, regardless of the HBe status [1]. In fact, it has been suggested that HBeAg-positive carriers with normal liver function tests cannot be considered "healthy" carriers because chronic hepatitis may return in these patients when an impaired immune function is restored [2]. On the other hand, the outcome of anti-HBe-positive carriers, as reported by Dr. Kiyosawa and colleagues, seems similar to the outcome we reported [3].
As far as the risk for hepatocellular carcinoma is concerned, in a recent follow-up study (>16 years) carried out in Canada, no cases of hepatocellular carcinoma were recognized in more than 400 HBsAg carriers who had initially normal liver function tests [4]. This corroborates our findings that the risk for hepatocellular carcinoma is low among Caucasian asymptomatic HBsAg carriers. On the other hand, a slightly increased risk has been found in Japan compared with the general population, both in HBsAg carriers with normal liver function tests [1], regardless of the HBe status, and in anti-HBe-positive carriers, regardless of liver function test results [5]. However, such risk has never been evaluated in truly healthy Japanese HBsAg carriers (that is, patients with normal liver function tests, and normal or nearly normal liver histologic findings).
1. Sakuma K, Takahara T, Okuda K, Tsuda F, Mayumi M. Prognosis of hepatitis B virus surface antigen carriers in relation to routine liver function tests: a prospective study. Gastroenterology. 1982; 83:114-7.
2. Hoofnagle JH, Shafritz DA, Popper H. Chronic type B hepatitis and the "healthy" HBsAg carrier state. Hepatology. 1987; 7:758-63.
3. 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.
4. Villeneuve JP, Desrochers M, Infante-Rivard C, Richer G. Long-term follow-up of healthy hepatitis B virus (HBV) carriers in Montreal (Abstract). Hepatology. 1992; 16:66A.
5. Sakuma K, Saitoh N, Kasai M, et al. Relative risks of death due to liver disease among Japanese male adults having various status for hepatitis B surface and e antigen/antibody in serum: a prospective study. Hepatology. 1988; 8:1642-6.
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