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Prognosis of Asymptomatic Hepatitis B Surface Antigen Carriers
- Roberto de Franchis, MD;
- Gianmichele Meucci, MD; and
- Maurizio Vecchi, MD
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IN RESPONSE:
We believe Dr. Kiyosawa and colleagues are correct that the main difference is the prevalence of HBeAg. This may account for the high morbidity and mortality rates found in Japanese HBsAg carriers who have initially normal liver function tests when evaluated, regardless of the HBe status [1]. In fact, it has been suggested that HBeAg-positive carriers with normal liver function tests cannot be considered healthy carriers because chronic hepatitis may return in these patients when an impaired immune function is restored [2]. On the other hand, the outcome of anti-HBe-positive carriers, as reported by Dr. Kiyosawa and colleagues, seems similar to the outcome we reported [3].
As far as the risk for hepatocellular carcinoma is concerned, in a recent follow-up study (>16 years) carried out in Canada, no cases of hepatocellular carcinoma were recognized in more than 400 HBsAg carriers who had initially normal liver function tests [4]. This corroborates our findings that the risk for hepatocellular carcinoma is low among Caucasian asymptomatic HBsAg carriers. On the other hand, a slightly increased risk has been found in Japan compared with the general population, both in HBsAg carriers with normal liver function tests [1], regardless of the HBe status, and in anti-HBe-positive carriers, regardless of liver function test results [5]. However, such risk has never been evaluated in truly healthy Japanese HBsAg carriers (that is, patients with normal liver function tests, and normal or nearly normal liver histologic findings).
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
