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Prognosis of Asymptomatic Hepatitis B Surface Antigen Carriers
- Kendo Kiyosawa, MD;
- Takeshi Sodeyama, MD; and
- Eiji Tananka, MD
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TO THE EDITOR:
de Franchis and colleagues [1] reported that Italian hepatitis B surface antigen (HBsAg) carriers with initially normal liver function test results have an excellent prognosis and a low risk for developing hepatocellular carcinoma. This differs in Japan. In adult Japanese HBsAg asymptomatic carriers with normal liver function test results and normal liver histology, 40% are hepatitis B e antigen (HBeAg)-positive carriers and 60% are anti-HBe-positive carriers [2]. The prognosis of HBeAg-positive asymptomatic HBsAg carriers appears to be poor. Of 32 HBeAg-positive carriers followed for an average of 13 years (range, 8 to 20 years), 16 (50%) developed hepatitis caused by hepatitis B virus infection; this was determined by IgM anti-hepatitis B core antigen positivity, anti-hepatitis D virus negativity, anti-hepatitis C virus (HCV) negativity, antinuclear antibody negativity, and no history of alcohol abuse. The remaining 16 carriers had normal liver function test results. Of the 16 patients who had hepatitis, 7 became anti-HBe-positive asymptomatic carriers and 9 had persistent HBeAg. Six patients had chronic active hepatitis, 2 had liver cirrhosis, and 1 had hepatocellular carcinoma. Conversely, 50 anti-HBe-positive asymptomatic HBsAg carriers followed for an average of 14 years (range, 8 to 18 years) had normal liver function test results and anti-HBe. No patient lost HBeAg. Although HCV infection is the major cause of hepatocellular carcinoma in Japan [3], HBV infection also appears to be important here.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
