Hepatitis B antigen (HBsAg) and/or antibodies (anti HBs and anti HBc) in fulminant hepatitis: pathogenic and prognostic significance

Abstract

Hepatitis B surface antigen (HB(s)Ag) and antibodies to both the surface and core antigens of the hepatitis B virus (anti HB(s) and anti HB(c)) have been studied in 64 consecutive cases of fulminant hepatitis. HB(s)Ag was detected by counterelectrophoresis in 23 (35.9%) but by radioimmunoassay in 38 (59.3%). Anti HB(s) was detected by passive haemagglutination in 26 (40.6%), coexisting HB(s)Ag and anti HB(s) were found in 16 cases (25%). Using an indirect immunofluorescence technique, anti HB(c) was found in all of the cases in whom either HB(s)Ag or anti HB(s) was present. The highest survival rate was observed in patients with no evidence of HBV infection (31.3%) and was lowest in those who had both HB(s)Ag and anti HB(s) detected simultaneously (6.2%). The prognosis of those who exhibited anti HB(s) only was no better than those with HB(s)Ag alone. In a further case, transient interruption of the asymptomatic chronic HB(s)Ag carrier state with seroconversion to anti HB(s) was associated with the development of a fulminant hepatitis syndrome. The results suggest that an unusually strong and rapid immune clearance of HB(s)Ag may be involved in the pathogenesis of fulminant hepatitis.