Summary
During a prospective study of acute symptomatic viral hepatitis, started in 1978, 664 consecutive adult patients, including 223 drug abusers, fulfilled the diagnostic criteria (anti-HBc IgM positivity) for acute type B hepatitis. In order to evaluate the outcome of the disease, 443 patients were followed for up to 12 months after the onset. 2.4% of the infections became chronic; the rate did not significantly differ between drug addicts and non-drug abusers, suggesting that chronic hepatitis is a rare complication of acute symptomatic hepatitis type B. Ongoing liver damage after clearance of HBsAg from serum was observed in drug abusers only (14% of the cases). Clinical, biochemical and virological features of the acute phase in patients with ongoing infection were compared with those of uncomplicated cases. Anicteric hepatitis and lower transaminase values were significantly (p<0.05) associated to a chronic evolution of the disease, as well as a higher prevalence of HBV-DNA, DNA polymerase and HBcAg positivity in serum. Testing HBV-DNA and DNA polymerase early in the course of the infection appeared to be of high predictive value for the subsequent outcome of the illness.
Zusammenfassung
Im Verlauf einer 1978 begonnenen, prospektiven Studie über die akute symptomatische B-Virus-Hepatitis wurde die Diagnose bei 664 Patienten gesichert (anti-HBc IgM-positiv); in dieser Gruppe waren 223 Drogensüchtige und 441 Nicht-Drogensüchtige. Verlaufsbeobachtungen erfolgten bei 443 der Patienten bis zu 12 Monate nach Ausbruch der Krankheit. 2,4% der Infektionen nahmen einen chronischen Verlauf, dabei bestanden zwischen den Drogensüchtigen und Nicht-Drogensüchtigen keine signifikanten Unterschiede. Dies deutet darauf hin, daß die akute symptomatische B-Virus-Hepatitis nur selten in die chronische Form übergeht. Ein Fortschreiten der Leberschädigung nach dem Verschwinden von HBsAg aus dem Serum wurde nur bei Drogensüchtigen (14% der Fälle) beobachtet. Die klinischen, biochemischen und virologischen Parameter der akuten Krankheitsphase wurden bei Patienten mit persistierender HBV-Infektion und bei Patienten mit unkompliziertem Verlauf verglichen. Eine anikterische Hepatitis und niedrigere Transaminasenwerte sowie eine höhere Prävalenz der HBV-DNA, DNA-Polymerase und HBcAg-Positivität waren signifikant mit einem chronischen Verlauf assoziiert (p<0,05). Die Testung der HBV-DNA und DNA-Polymerase in der Frühphase der Infektion hat sich als sehr wertvoll für die Prognose des weiteren Krankheitsverlaufes erwiesen.
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Bortolotti, F., Armigliato, M., Alberti, A. et al. Chronic evolution of acute hepatitis type B: Prevalence and predictive markers. Infection 14, 64–67 (1986). https://doi.org/10.1007/BF01644444
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DOI: https://doi.org/10.1007/BF01644444