Chronic asymptomatic HBsAg carriers: histologic abnormalities and diagnostic and prognostic value of serologic markers of the HBV

Liver histology, the serum 'e' antigen system, and DNA-polymerase activity were studied in 68 chronic asymptomatic HB(s)Ag carriers with normal liver chemistries in order to assess the frequency of chronic hepatitis and the diagnostic and prognostic usefulness of serum HBV markers in these subjects. Liver histology was normal in 3 cases, showed non-specific changes in 46, chronic-persistent hepatitis in 16, and moderate chronic active hepatitis in 3. The 'e' antigen and DNA-polymerase activity were positive in 2 and 5 cases, respectively, and were associated with either minimal inflammatory changes or chronic-persistent hepatitis. The 'e' antibody was found in 28, evenly distributed among the various histologic categories; 2 out of 3 patients with chronic active hepatitis carried the 'e' antibody. Sixty-four patients have been followed prospectively for 12-30 mo with serial liver tests. During follow-up, 1 patient, with minimal inflammatory changes on liver biopsy and negative for 'e' antigen, antibody or DNA-polymerase activity, developed consistently abnormal transaminases, and showed progression to chronic active hepatitis on repeat biopsy. In another patient with chronic-persistent hepatitis, 'e' antigen and DNA-polymerase activity reverted to entirely normal serologic status. In our large series, the frequency of chronic hepatitis among HB(s)Ag carriers with normal liver chemistries was somewhat higher than previously reported. In these subjects, the 'e' antigen status did not correlate closely with liver histology and did not seem to provide reliable short-term prognostic information.