Hepatic morphologic findings and viral antigens in acute hepatitis B

Abstract

In the course of a prospective clinical study, 26 liver biopsies were taken in 24 previously healthy patients with an uncomplicated acute hepatitis B (AHB) and a subsequent complete recovery (UR group). Serum transaminase levels were used to distinguish four AHB stages, as the variability in duration made time dependent staging less appropriate. As a reference, a second group of 22 liver biopsies from 7 patients from the same prospective clinical study who eventually developed chronic hepatitis (CH group) was included. Due to fluctuations of transaminase levels in this group the stages two and three could not be separated, stage four was not reached within the follow-up period of median 5 years. Histopathological criteria and the distribution patterns of hepatitis B surface (HBsAg) and core (HBcAg) antigens were studied. Piecemeal necrosis and bridging hepatic necrosis were a frequently occurring feature in the liver biopsies of the UR group taken during the stage of peak transaminase levels. In this respect, no differences could be demonstrated between the UR group and the CH group. The occurrence of these features in AHB thus appears to have no prognostic value as risk factor for chronic liver disease. In contrast, diffuse cytoplasmic (‘ground glass’) HBsAg localization was only found in stage 2/3 of the CH group. It is concluded that apart from ground glass cells, care must be taken to interpret any histopathological feature in AHB as risk factor of progression to chronicity without reference to the duration of illness. The possible significance regarding the host's immune mechanisms of some features that may persist during chronic liver disease is discussed.