RESUMO
Background: Although chronic hepatitis B virus infections are common in Egypt, the incidentally discovered asymptomatic forms are very frequent. Their serological profile and clinical significance have not been determined
Aim: to characterize the clinical, serological and histological liver damage among incidentally detected asymptomatic hepatitis B surface antigen [HBsAg]-positive subjects [IDAHS] in Egypt
Methods: we prospectively studied 70 consecutive IDAHS patients who were long term HBsAg carriers. Tests for liver function, serological markers for HBV, HCV, HDV and schistosomiasis were done for all patients. HBV DNA was determined by the branched DNA technique and PCR at the core promotor/precore region and the S region. Liver biopsy specimens from 44 patients were studied and scored for activity and fibrosis stage by modified Knodell score and the METAVIR score. HBsAg and HBcAg were immunohistochemically evaluated in the liver tissue
Results: of the studied 70 patients, 57 [81.6%] were HBeAg negative and 13 [18.4%] were HBeAg positive. There was statistically significantly elevated hepatic transaminases in HBeAg-positive patients when compared to HBeAg-negative patients. HBV DNA was detected in only 3% of patients by the b-DNA technique and in 97% by the PCR techniques. Coinfection with HDV was found in 4.2% of patients. Pathological examination of liver tissue revealed mild activity in 21 [47.7%] of patients. Also, 21 patients [47.7%] revealed mild to moderate expansion of portal areas while 7 patients [15.9%] showed bridging fibrosis and no patient was cirrhotic
Conclusion: among 1DAHS sub jects, the majority are HBeAg negative without elevation of hepatic transaminases. They should be considered patients since viremia is detected in almost all cases using PCR technique, and histopathological evidence of chronic hepatitis B virus infection and liver damage is noted in varying degrees
RESUMO
One hundred serum samples from patients with non-B hepatitis-related chronic liver disease were tested by the first generation anti-HCV ELISA [ortho] and the second generation anti-HCV enzyme immunoassay [abbott] and a recombinant immunoblot assay [RIBA 2, chiron] in order to study the specificity of the second generation tests. The tested polymerase chain reactions [PCRs] were performed to confirm that discrepancies that were observed could be due to the presence of low levels of anti-HCV antibodies, which were detected by a more sensitive test, or to nonspecific positive reactions. In non-B hepatitis- related chronic liver disease, the second generation enzyme-linked immunosorbent assay and second generation recombinant immunoblot assay showed 98% positivity, whereas first enzyme-linked generation immunosorbent assay showed 89% positivity. The two second generation recombinant immunoblot assay-negative samples were positive by tested polymerase chain reactions. The tested polymerase chain reaction revealed the presence of HCV RNA sequences in all anti-HCV positive sera or sera that were weakly positive by second generation tests. Anti-HCV positivity by RIBA 2 was always correlated with the presence of viral RNA in serum, but HCV RNA was detected in RIBA 2-negative sera. These results indicated that the specificity of the second generation tests is an important improvement but that an HCV infection can still persist without detectable antibodies. PCR remains the reference assay to clear up controversial serology results and to detect HCV infection in patients with no anti-HCV detectable immune response