Hepatitis B-associated polyarteritis nodosa in alaskan eskimos: Clinical and epidemiologic features and long-term follow-up

Authors

  • Brian J. McMahon M.D.,

    Corresponding author
    1. Alaska Native Medical Center, Alaska Area Native Health Service, Indian Health Service, Anchorage, Alaska 99510; Arctic Investigations Laboratory, Center for Infectious Diseases, Centers for Disease Control, Anchorage, Alaska 99501, and Yukon-Kuskokwim Delta Regional Hospital, Alaska Area Native Health Service, Indian Health Service, Bethel, Alaska 99559
    • Department of Medicine, Alaska Native Medical Center, P.O. Box 107741, Anchorage, Alaska 99510-7741
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  • William L. Heyward,

    1. Alaska Native Medical Center, Alaska Area Native Health Service, Indian Health Service, Anchorage, Alaska 99510; Arctic Investigations Laboratory, Center for Infectious Diseases, Centers for Disease Control, Anchorage, Alaska 99501, and Yukon-Kuskokwim Delta Regional Hospital, Alaska Area Native Health Service, Indian Health Service, Bethel, Alaska 99559
    Current affiliation:
    1. AIDS Program, Centers for Disease Control, Atlanta, Georgia 30333
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  • David W. Templin,

    1. Alaska Native Medical Center, Alaska Area Native Health Service, Indian Health Service, Anchorage, Alaska 99510; Arctic Investigations Laboratory, Center for Infectious Diseases, Centers for Disease Control, Anchorage, Alaska 99501, and Yukon-Kuskokwim Delta Regional Hospital, Alaska Area Native Health Service, Indian Health Service, Bethel, Alaska 99559
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  • David Clement,

    1. Alaska Native Medical Center, Alaska Area Native Health Service, Indian Health Service, Anchorage, Alaska 99510; Arctic Investigations Laboratory, Center for Infectious Diseases, Centers for Disease Control, Anchorage, Alaska 99501, and Yukon-Kuskokwim Delta Regional Hospital, Alaska Area Native Health Service, Indian Health Service, Bethel, Alaska 99559
    Current affiliation:
    1. MRA Box 49, Van Buren Rd., Caribou, Maine 04736
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  • Anne P. Lanier

    1. Alaska Native Medical Center, Alaska Area Native Health Service, Indian Health Service, Anchorage, Alaska 99510; Arctic Investigations Laboratory, Center for Infectious Diseases, Centers for Disease Control, Anchorage, Alaska 99501, and Yukon-Kuskokwim Delta Regional Hospital, Alaska Area Native Health Service, Indian Health Service, Bethel, Alaska 99559
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Abstract

We analyzed the demographic, clinical, laboratory and histologic features of 13 patients who were diagnosed as having polyarteritis nodosa associated with hepatitis B virus infection over a 12-year period, 1974 to 1985. All 13 patients were Yupik Eskimos and resided in southwest Alaska, an area hyperendemic for hepatitis B virus infection. The annual incidence of hepatitis B virus-associated polyarteritis nodosa for this population is 7.7 cases per 100,000 population. All patients presented with multisystem disease, and all had biopsy or angiographic findings consistent with polyarteritis nodosa. All 13 were positive for hepatitis B surface antigen and hepatitis B e antigen at diagnosis. Two untreated patients and two of five patients who received corticosteroids died, vs. none of six who received corticosteroids plus cyclophosphamide. None of the patients who survived the initial bout of polyarteritis nodosa has relapsed after a mean follow-up of 55 months, but all have become chronic HBsAg carriers. In eight patients, clinical or serologic evidence indicated that polyarteritis nodosa followed recent hepatitis B virus infection. We concluded that hepatitis B virus-associated polyarteritis nodosa is a serious, life-threatening complication that occurs early in the course of hepatitis B virus infection, is ameliorated by immunosuppressive therapy and can be prevented by hepatitis B vaccine.

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