Hepatitis B virus infection in southern African blacks with hepatocellular cancer.

The association between hepatitis B virus (HBV) infection and hepatocellular cancer (HCC) in southern African blacks was investigated by examination of patients' sera for all the currently known markers of HBV. Hepatitis B surface antigen (HBsAg) was present in the sera of 61.6% (178/289) of the patients compared with only 11.3% (24/213) of age-matched, sex-matched, and ethnically matched controls (P less than 0.001). Antibody against HBsAg was found in 17% of the patients and 41.7% of the controls (P less than 0.001). In 74 patients studied in more detail, antibody against the hepatitis B core antigen (anti-HBc) was detected in 89%, almost always in high or moderately high titer. Anti-HBc was found in 37.5% of the controls. Active HBV infection, as indicated by positive tests for HBsAg or anti-HBc, was present in 91% of the patients compared with 39.4% of the controls (P less than 0.001). Hepatitis B e-antigen was detected in 2.3% and its specific antibody in 20.5% of the patients. The corresponding figures in the controls were 0 and 55%. HBs antigenemia was more common in younger patients with HCC. No relationship was demonstrated between alpha-fetoprotein and HBs antigenemia. HBV infection was equally common in patients with and without cirrhosis in the nontumorous liver.

Carcinoembryonic antigen in hepatocellular cancer.

Serum carcinoembryonic antigen (CEA) concentrations were found to be raised in 28 of 72 black patients (39%) with hepatocellular cancer (HCC). The degree of elevation was slight or moderate, except in 3 patients in whom values greater than 20 ng/ml were recorded. No significant correlation could be demonstrated in individual patients between the serum CEA concentration and various tests of liver function. The mean CEA value in the patients with cirrhosis in the non-tumorous liver was slightly higher than that in those without cirrhosis, but the difference did not reach statistical significance. There was no correlation between serum CEA and alpha-foetoprotein (AFP) levels.

Serum and tumour ferritins in primary liver cancer.

Serum ferritin concentrations were found to be raised, often considerably, in 58 of 76 black patients with primary liver cancer (PLC). No correlation could be demonstrated between the serum ferritin concentration and several other measurements, including the following: hepatic iron stores measured chemically, the size of the tumour, serum transaminase values, and the presence or absence of cirrhosis in the non-tumorous liver. There was, however, a negative correlation between serum ferritin and alpha-foetoprotein concentrations. Ferritin was purified from PLC tissue obtained from three patients at necropsy and the distribution of isoferritins was determined by isoelectric focusing. Acidic isoferritins similar to those previously found in PLC tissue were obtained. Their acidic nature was confirmed chromatographically using DEAE cellulose. Because the serum ferritin in patients with PLC probably consists of a mixture of normal and acidic isoferritins, it is likely that the serum assay used in the present study underestimated the actual concentrations present. With the development of an assay which utlises a specific antibody against acidic PLC isoferritins, serum ferritin may prove to be a second marker for PLC.

Hepatitis-B surface antigen and antibody in Black and White patients with venereal diseases.

The prevalence of both the hepatitis-B surface antigen (HBsAg) and its specific antibody (anti-HBs) was significantly greater in the sera of White patients suffering from sexually transmitted diseases than that in White blood donors. However, Black patients with venereal diseases did not show an increased prevalence of either HBsAg or anti-HBs. These findings support the view that heterosexual transmission of the hepatitis-B virus is less likely to occur in populations in whom this infection is largely acquired before the age of sexual maturity.

Hepatitis-B virus infection in anaesthetists.

To determine whether anaesthetists are at risk from developing hepatitis-B virus (HBV) infection from their patients, 95 anaesthetists working with black South Africans (who have a high prevalence of hepatitis-B antigenaemia) were questioned about attacks of viral hepatitis and their blood was tested for hepatitis-B (surface) antigen (HBsAg) and antibody (Anti-HBs). Anti-HBs was detected in the serum of 17.9% of the anaesthetists, but none was a chronic carrier of HBsAg. Two anaesthetists had suffered from acute viral hepatitis during their careers, one of whom is now positive for Anti-HBs. Forty-five of the anaesthetists (47.4%) were known to have anaesthetized patients with HBs antigenaemia, and of these seven were Anti-HBs-positive. Anaesthetists working with a population having a high carrier rate of HBV appear to be more at risk from HBV infection than the general population.

Hepatitis B antigen, hepatitis B antibody, and subtypes in leprosy.

The prevalence of hepatitis B antigen (HBsAg), hepatitis B antibody (HBsAb), and subtypes in 242 cases of leprosy is reported. Patients were divided into three subgroups, lepromatous (174), tuberculoid (55), and borderline (13). A total of 131 patients were tested on admission; the remaining 111 had been institutionalized for a period of 3 months or more when tested. Of the 131 cases tested on admission, 88 were retested 6 to 12 months after admission. There was no statistical difference in the incidence of HBsAg and HBsAb among the three groups or between normal controls and the leprosy patients. The predominant subtype was ADW (84.1%). After institutionalization, one lepromatous case converted to HBsAg positive and four converted to HBsAb positive.

Prevalence of hepatitis B surface antigen and antibody in white and black patients with diabetes mellitus.

The prevalence of hepatitis B surface antigen (HBSAg) and antibody (anti-HBS) was determined in 531 white and 519 black diabetic outpatients and in appropriate white and black control populations. There was no difference between the prevalence of either HBSAg or anti-HBS in either the white or black diabetics and that in the white and black controls. These findings make it unlikely that the vast majority of patients with diabetes mellitus have either an increased susceptibility to infection by the hepatitis B virus or an impaired ability to clear the virus once they are infected.

Hepatitis B surface antigen produced by a human hepatoma cell line.

The human hepatoma cell line, PLC/PRF/5, was shown to produce hepatitis B surface antigen (HBsAg). Immunologically reactive material was present in the supernatant tissue culture medium in significant amounts, and was associated with spherical particles approximately 20 nm in diameter. The rate of antigen production by the cells was estimated at 500 ng/day/10(6) cells by reference to a purified HBsAg standard. All immunological activity was neutralized by specific antibody and the subtype was ad. The studies reported here broaden the scope of investigations on both the in vitro production of HBsAg and the association between this antigen and primary liver cancer.

Hepatitis-B surface antigen and antibody in Bantu patients with primary hepatocellular cancer.

Hepatitis-B surface antigen (HBsAg) was found in the serum of 58 of 158 (36-4%) southern African Bantu patients with primary hepatocellular cancer by counter immunoelectrophoresis and in 94 (59-5%) by radioimmunoassay (RIA). The prevalence of this antigen in the general Bantu population using these methods was 7% and 9% respectively. Antibody against HBsAg was detected in 11-6% of the patients by passive haemagglutination (PH) and 13-4% by RIA, and in 33-4% (by PH) of a control population. Antibody sub-types were predominantly "adw" (69-2%) with a lesser frequency of "ayw" (23%), while 7-8% were indeterminate. The corresponding figures in the controls were 80-4, 8-4 and 11-2%. HBsAg was more common in younger patients. No relationship could be demonstrated between hepatitis-B antigenaemia and the presence of alpha-foetoprotein in high concentration, although there were far fewer patients in the alpha-foetoprotein-negative group.

Serum immunoglobulin levels in White and Black patients with virus-A and-B hepatitis.

Serum immunoglobulin G, M and A levels were measured in 106 White patients with acute virus-A (hepatitis-B surface antigen-negative) hepatitis and 27 White patients with acute virus-B (hepatitis-B surface antigen-positive) hepatitis and compared with the values previously obtained in Black patients with these diseases. The mean serum IgM level in the White patients with virus-A hepatitis was significantly higher than that in virus-B hepatitis (p less than 0,001). This difference was much more obvious than that in Black patients, mainly due to a much lower mean serum IgM response in Black patients with virus-A hepatitis. The reason for the blunted IgM response in Black patients with virus-A hepatitis is not known, but it may be related to a difference in the reaction against altered host tissues rather than any difference in antibody production against the virus per se. The mean serum IgG and IgA levels were not significantly different in the White patients with virus-A and virus-B hepatitis and they were lower than the corresponding figures in Blacks.

Serum immunoglobulin levels in primary liver cancer: relationship to underlying cirrhosis and hepatitis-B (surface) antigenaemia.

Serum IgG, IgM and IgA levels were measured by the single radial diffusion method in 107 South African Negro patients with primary hepatocellular cancer (PHC) and 112 healthy Negro blood donors. The mean serum IgG ANd IgM concentrations were significantly higher (P less than 0-001) in the PHC patients. In those patients in whom PHC was associated with cirrhosis, the serum IgG level was greater (P less than 0-02) than in those without cirrhosis. However, the mean serum IgG concentration in the non-cirrhotic cancer patients was still significantly higher than the control value (P less than 0-001). Thus, while cirrhosis may contribute to the raised IgG levels in PHC, other factors must also be involved. There was no difference in the serum immunoglobulin concentrations in PHC patients with and without hepatitis-B antigenaemia.

Hepatitis B (surface) antigen in mothers and their infants.

Hepatitis B (surface) antigen (HBSAg) was found in the serum of 8 out of 4 245 women attending the antenatal clinic of the Queen Victoria Maternity Hospital Seven (0, 16%) were asymptomatic carriers of the antigen, while the eigth suffered from polyarteritis nodosa. Seven of the 8 babies born to these mothers were followed-up over periods of up to 18 months, and 1 has become a chronic carrier of HBSAg. The antigen was not detected in the colostrum (breast milk) of the 6 positive mothers tested, but it was present in amniotic fluid, placenta and cord blood of some of the mother-infant couples. The possible routes of transmission of the hepatitis B virus from mother to baby are discussed in the light of these findings. No cases of acute virus B hepatitis occurred in the latter months of pregnancy nor in the puerperium, among 4 088 women delivered at the hospital during this period.

Serum immunoglobulin levels in hepatitis-B antigen-positive and hepatitis-B antigen-negative acute hepatitis.

IgG, IgA and IgM levels were measured in the serum of 73 patients with hepatitis-B antigen-positive (virus-B) acute hepatitis and 48 patients with hepatitis-B antigen-negative (virus-A) hepatitis. The mean serum IgM level on admission was significantly higher in virus-A than in virus-B hepatitis (p less than 0,01), and remained so for 2-3 weeks. However, the overlap between the individual figures in the two forms of the disease was so great as to make the estimation of little diagnostic value. The mean serum IgG and IgA levels at the time of admission were not significantly different in the patients with and without hepatitis-B anti-genaemia.