What should we clinicians do for healthy, asymptomatic, hbsag-positive carriers?
Article first published online: 5 DEC 2005
Copyright © 1993 American Association for the Study of Liver Diseases
Volume 18, Issue 4, pages 1014–1016, October 1993
How to Cite
McMahon, B. J. (1993), What should we clinicians do for healthy, asymptomatic, hbsag-positive carriers?. Hepatology, 18: 1014–1016. doi: 10.1002/hep.1840180439
- Issue published online: 5 DEC 2005
- Article first published online: 5 DEC 2005
Objective: To assess the long-term outcome in hepatitis B surface antigen (HBsAg) carriers who have normal liver function tests, focusing on survival and the development of severe liver disease and hepatocellular carcinoma.
Design: Cohort study with a mean follow-up of 130 months.
Setting: Liver clinic of a referral center.
Patients: Ninety-two HBsAg-positive blood donors with normal liver function tests.
Measurements: Histologic evaluation of liver specimens at baseline; clinical, biochemical, and serologic follow-up; and repeat liver biopsy if clinically indicated or after 10 years of follow-up.
Results: At baseline, 69 subjects had normal histologic findings or only minor abnormalities, 18 had chronic persistent hepatitis, and 5 had mild chronic active hepatitis. Serum enzyme levels remained normal in 58 of 68 patients who had regular follow-up. Three patients had biochemical changes consistent with hepatitis B virus (HBV) infection; in one of these patients, a later histologic evaluation showed progression to chronic active hepatitis. One patient developed alcoholic cirrhosis. Six other patients had mild or transient transaminase elevations, with no evidence of HBV replication, hepatitis D virus infection, hepatitis C virus (HCV) infection, or histologic deterioration. Liver histologic findings also remained unchanged in 21 patients who showed no biochemical changes during 10 years of follow-up and consented to have repeated liver biopsy. Ten patients showed loss of HBsAg; 2 of these patients acquired antibody to hepatitis B surface antigen (anti-HBs). All patients who did not have regular follow-up, except 1, were interviewed by telephone during 1990; All denied having liver disease. No patients developed hepatocellular carcinoma.
Conclusions: Italian HBsAg carriers with initially normal liver function tests have an excellent prognosis: Delta superinfection is infrequent and the risk for developing hepatocellular carcinoma is low.