Liver diseases and hepatitis B virus antigens and antibodies in chronic HBsAg carriers in childhood

Abstract

Liver biopsies were obtained from 109 children who had been chronic carriers of HBsAg for more than 6 months. The specimens were examined for the presen Ice of intracellular HBsAg, HBcAg and HBeAg by direct immunofluorescence. Sera were tested for HBeAg, virus B specific DNA polymerase, anti-HBs, anti-HBe and anti-HBc. On the basis of accepted histological criteria we found chronic active hepatitis (CAH) in 56 and chronic persistent hepatitis (CPH) in 19 children. 15 cases had minimal changes (minimal hepatitis, MH) and 19 normal liver tissue (healthy HBsAg carriers, HC). Children with CAH and CPH had HBeAg, DNA polymerase and anti-HBc in their serum. HBcAg and HBeAg were found in 5-50% of the nuclei and HBsAg mostly in a lower percentage in the cytoplasm of hepatocytes. All cases with MH and 10 of 19 HC had also HBeAg positive sera. DNA polymerase showed higher activities and anti-HBc lower titers compared with CAH and CPH. HBcAg and HBeAg were detected in 50-90% of liver cell nuclei. 9 HC had only HBsAg in their hepatocytes and showed anti-HBe in serum. MH and HC have been first described in childhood land differentiated from other types of chronic HBsAg positive hepatitis. HC occurred both with and without persistent virus B infection. Furthermore,the study demonstrates that the presence of HBeAg and DNA polymerase in serum are closely associated with HBcAg and HBeAg expression in liver cell nuclei. It is suggested that immune responsiveness determines the variable reaction patterns of virus B antigens and antibodies as well as the form of hepatitis.