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Pathology and Immunopathology of Acute and Chronic Hepatitis B

  • Michael A. Gerber

Abstract

This chapter describes the pathologic characteristics of acute and chronic hepatitis B, as derived from our current knowledge of the biology of hepatitis S virus (HBV)1 and of the immunopathology of the disease.2 Since the precise mechanism of hepatocyte necrosis by HBV is still unknown, some of the information presented here is speculative.

Keywords

Chronic Hepatitis Viral Hepatitis Chronic Active Hepatitis Portal Tract Acute Viral Hepatitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Gerber MA, Thung SN: Molecular and cellular pathology of hepatitis B. Lab Invest 52:572–590, 1985.PubMedGoogle Scholar
  2. 2.
    Gerber MA: Immunopathology of chronic hepatitis, in Phillips MJ, and Farber E (eds): Pathogenesis of Liver Diseases. IAP Monograph No. 28. Williams & Wilkins, Baltimore, 1986, pp. 54–64.Google Scholar
  3. 3.
    Alberti A, Tremolada F, Fattovich G, et al: Virus replication and liver disease in chronic hepatitis S virus infection. Dig Dis Sci 28:961–996, 1983.PubMedCrossRefGoogle Scholar
  4. 4.
    Bonino F, Hoyer B, Nelson J, et al: Hepatitis S virus DNA in the sera of HBsAg carriers: A marker of active hepatitis S virus replication in the liver. Hepatology 1:386–391, 1981.PubMedCrossRefGoogle Scholar
  5. 5.
    Davis GL, Hoofnagle JH, Waggoner JG: Spontaneous reactivation of chronic hepatitis S virus infection. Gastroenterology 86:230–235, 1984.PubMedGoogle Scholar
  6. 6.
    Sjögren M, Hoofnagle JH, Gerin JL: IgM antibody to hepatitis S core antigen in patients with chronic type S hepatitis. Gastroenterology 89:252–258, 1985.PubMedGoogle Scholar
  7. 7.
    Alberti A, Realdi G, Tremolada F, et al: Liver cell surface localization of hepatitis S antigen and of immunoglobulins in acute and chronic hepatitis and in liver cirrhosis. Clin Exp Immunol 25:396–402, 1976.PubMedGoogle Scholar
  8. 8.
    Lamothe F, Laurencin-Piché J, Cote J, et al: Detection of surface and core antigens of hepatitis S virus in the liver of 164 human subjects. Gastroenterology 71:102–108, 1976.PubMedGoogle Scholar
  9. 9.
    Portmann B, Galbraith RM, Eddieston ALWF, et al: Detection of HBsAg in fixed liver tissue: use of a modified immunofluorescence technique: Comparison with histochemical methods. Gut 17:1–9, 1976.PubMedCrossRefGoogle Scholar
  10. 10.
    Ray MB: Hepatitis S virus Antigens in Tissues. MTP Press, Lancaster, England, 1979.CrossRefGoogle Scholar
  11. 11.
    Gerber MA, Thung SN: Pathobiology of hepatitis S virus. Pathobiol Annu 11:197–228, 1981.PubMedGoogle Scholar
  12. 12.
    Hadziyannis S, Gerber MA, Vissoulis C, et al: Cytoplasmic hepatitis S antigen in“ground-glass,” hepatocytes of carriers. Arch Pathol Lab Med 96:327–330, 1973.Google Scholar
  13. 13.
    Gerber MA, Hadziyannis S, Vissoulis C, et al: Electron-microscopy and immunoelectron microscopy of cytoplasmic hepatitis S antigen in hepatocytes. Am J Pathol 75:489–502, 1974.PubMedGoogle Scholar
  14. 14.
    Gerber MA, Hadziyannis S, Vernace S, et al: Incidence and nature of cytoplasmic hepatitis S antigen in hepatocytes. Lab Invest 32:251–256, 1975.PubMedGoogle Scholar
  15. 15.
    Sureau C, Romet-Lemonne JL, Mullins JI, et al: Production of hepatitis S virus by a differentiated human hepatoma cell line after transfection with cloned circular HBV DNA. Cell 47:37–47, 1986.PubMedCrossRefGoogle Scholar
  16. 16.
    Tsurimot T, Fujiyama A, Matsubara K: Stable expression and replication of hepatitis S virus genome in an integrated state in a human hepatoma cell line transfected with the cloned viral DNA. Proc Natl Acad Sci USA 84:444–448, 1987.CrossRefGoogle Scholar
  17. 17.
    Sells MA, Chen M-L, Acs G: Production of hepatitis S virus particles in Hep G2 cells transfected with cloned hepatitis S virus DNA. Proc Natl Acad Sci USA 84:1005–1009, 1987.PubMedCrossRefGoogle Scholar
  18. 18.
    Bechtelsheimer H, Gedigk P, Muller R, et al: Aggressive Emperipolese bei chronischen Hepatitiden. Klin Wochenschr 54:137–140, 1976.PubMedCrossRefGoogle Scholar
  19. 19.
    Gerber MA, Thung SN: Viral hepatitis: Pathology, in Berk JE, Haubrich WS, Kaiser SS, Roth JLA, Schaffner F (eds): Bockus Gastroenterology, Vol. V: The Liver, 4th ed. WB Saunders, Philadelphia, 1985, pp. 2225–2235.Google Scholar
  20. 20.
    Ishak KG: Light microscopic morphology of viral hepatitis. Am J Clin Pathol 65:787–827, 1976.PubMedGoogle Scholar
  21. 21.
    Bianchi L, Simmerli-Ning M, Gudat F: Viral hepatitis, in MacSween RNM, Anthony PP, Scheuer PJ (eds): Pathology of Liver. Churchill Livingstone, Edinburgh, 1979, pp. 164–191.Google Scholar
  22. 22.
    MacSween RNM: Pathology of viral hepatitis and its sequelae. Clin Gastroenterol 9:23–45, 1980.Google Scholar
  23. 23.
    Scheuer PJ: Liver Biopsy Interpretation, 3rd ed. Balliere Tindall, London, 1980.Google Scholar
  24. 24.
    Review by an International Group: Morphological criteria in viral hepatitis. Lancet 1:333–337, 1971.Google Scholar
  25. 25.
    Review by an International Group: Acute and chronic hepatitis revisited. Lancet 2:914–919, 1977.Google Scholar
  26. 26.
    Popper H, Dienstag JL, Feinstone SM, et al: Pathology of viral hepatitis in chimpanzees. Virchows Arch A Pathol Anat Histol 387:91–106, 1980.PubMedCrossRefGoogle Scholar
  27. 27.
    Peters RL: Viral hepatitis: A pathological spectrum. Am J Med Sci 270:17–31, 1975.PubMedCrossRefGoogle Scholar
  28. 28.
    Phillips MJ, Poucell S: Modern aspects of the morphology of viral hepatitis. Hum Pathol 12:1060–1084, 1981.PubMedCrossRefGoogle Scholar
  29. 29.
    Hadziyannis SJ, Lieberman HM, Karvountzis GG, et al: Analysis of liver disease, nuclear HBcAg viral replication, and hepatitis S virus DNA in liver and serum of HBeAg, vs. anti-HBe positive carriers of hepatitis S virus. Hepatology 3:656–662, 1983.PubMedCrossRefGoogle Scholar
  30. 30.
    Hoofnagle JH: Chronic type S hepatitis. Gastroenterology 84:422–424, 1983.PubMedGoogle Scholar
  31. 31.
    Shafritz DA, Rogler CE: Molecular characterization of viral forms observed in persistent hepatitis infections, chronic liver disease and hepatocellular carcinoma in woodchucks and humans, in Vyas GN, Dienstag JL, Hoofnagle JH (eds): Viral Hepatitis and Liver Disease. Grune & Stratton, Orlando, Florida, 1984, pp. 225–243.Google Scholar
  32. 32.
    Burrell CJ, Gowans EJ, Jilbert AR, et al: Hepatitis S virus DNA detection by in situ cytohybridization: Implications for viral replication strategy and pathogenesis of chronic hepatitis. Hepatology 2(suppl):85S–91S, 1982.Google Scholar
  33. 33.
    Trevisan A, Realdi G, Alberti A, et al: Core antigen-specific immunoglobulin G bound to the liver cell membrane in chronic hepatitis B. Gastroenterology 82:218–222, 1982.PubMedGoogle Scholar
  34. 34.
    Alter HJ, Seef LB, Kaplan PM, et al: Type S hepatitis: the infectivity of blood positive for e antigen and DNA polymerase after accidental needlestick exposure. S Engl J Med 295:909–913, 1976.CrossRefGoogle Scholar
  35. 35.
    Hoofnagle JH, Alter HJ: Chronic viral hepatitis, in Vyas GN, Dienstag JL, Hooffnagle JH (eds): Viral hepatitis and Liver Disease. Grune & Stratton, Orlando, Florida, 1984, pp. 97–113.Google Scholar
  36. 36.
    Smith JI, Murphy BI, Auslander MO, et al: Studies of the“e”antigen in acute and chronic hepatitis. Gastroenterology 71:208–219, 1976.PubMedGoogle Scholar
  37. 37.
    Yokosuka O, Omata M, Imazeki F, et al: Hepatitis S virus RNA transcripts and DNA in chronic liver disease. S Engl J Med 315:1187–1192, 1986.CrossRefGoogle Scholar
  38. 38.
    Colucci G, Colombo M, Del Ninno E, et al: In situ characterization by monoclonal antibodies of the mononuclear cell infiltrate in chronic active hepatitis. Gastroenterology 85:1138–1145, 1983.PubMedGoogle Scholar
  39. 39.
    Eggink HF, Houthoff HJ, Huitema S, et al: Cellular and humoral immune reactions in chronic active liver disease. I. Lymphocyte subsets in liver biopsies of patients with untreated idiopathic autoimmune hepatitis, chronic active hepatitis S and primary biliary cirrhosis. Clin Exp Immunol 50:17–24, 1982.PubMedGoogle Scholar
  40. 40.
    Govindarajan S, Uchida T, Peters RL: Identification of S lymphocytes and subsets in liver biopsy cores of acute viral hepatitis. Liver 3:13–18, 1983.PubMedGoogle Scholar
  41. 41.
    Husby G, Blomhoff JP, Elgio K, et al: Immunohistochemical characterization of hepatic tissue lymphocyte subpopulations in liver disease. Scand J Gastroenterol 17:855–860, 1982.PubMedCrossRefGoogle Scholar
  42. 42.
    Montano L, Aranguibel F, Boffill M, et al: An analysis of the composition of the inflammatory infiltrate in autoimmune and hepatitis S virus-induced chronic liver disease. Hepatology 3:292–296, 1983.PubMedCrossRefGoogle Scholar
  43. 43.
    Nishihara T: Intrahepatic distribution of S cell subsets in cases with type S chronic liver disease by peroxidase-labeled antibody method using monoclonal antibodies. Gastroenterol Jpn 18:320–329, 1983.PubMedGoogle Scholar
  44. 44.
    Pape GR, Rieber EP, Eisenburg J, et al: Involvement of the cytotoxic suppressor T-cell subset in liver tissue injury of patients with acute and chronic liver diseases. Gastroenterology 85:657–662, 1983.PubMedGoogle Scholar
  45. 45.
    Si L, Whiteside TL, Van Thiel DH, et al: Lymphocyte subpopulations at the site of“piecemeal”necrosis in end stage chronic liver diseases and rejecting liver allografts in cyclosporine-treated patients. Lab Invest 50:341–347, 1984.PubMedGoogle Scholar
  46. 46.
    Thomas HC, Montano L, Goodall A, et al: Immunological mechanisms in chronic hepatitis S virus infection. Hepatology 2(suppl):116S–121S, 1982.CrossRefGoogle Scholar
  47. 47.
    Eddleston ALWF, Mondelli M, Mieli-Vergani G, et al: Lymphocyte cytotoxicity to autologous hepatocytes in chronic hepatitis S virus infection. Hepatology 2(suppl):122S–127S, 1982.Google Scholar
  48. 48.
    Mieli-Vergani G, Vergani D, Portmann B, et al: Lymphocyte cytotoxicity to autologous hepatocytes in HBsAg positive chronic liver disease. Gut 23:1029–1036, 1982.PubMedCrossRefGoogle Scholar
  49. 49.
    Mondelli M, Eddleston AL: Mechanisms of liver cell injury in acute and chronic hepatitis B. Semin Liver Dis 4:47–58, 1984.PubMedCrossRefGoogle Scholar
  50. 50.
    Mondelli M, Mieli-Vergani G, Alberti A, et al: Specificity of S lymphocyte cytotoxicity to autologous hepatocytes in chronic hepatitis S virus infection: evidence that S cells are directed against HBV core antigen expressed on hepatocytes. J Immunol 129:2773–2778, 1982.PubMedGoogle Scholar
  51. 51.
    Naumov NV, Mondelli M, Alexander GJ, et al: Relationship between expression of hepatitis S virus antigens in isolated hepatocytes and autologous lymphocyte cytotoxicity in patients with chronic hepatitis S virus infection. Hepatology 4:63–68, 1984.PubMedCrossRefGoogle Scholar
  52. 52.
    Thomas HC, Lok AS: The immunopathology of autoimmune and hepatitis S virus-induced chronic hepatitis. Semin Liver Dis 4:36–46, 1984.PubMedCrossRefGoogle Scholar
  53. 53.
    Houthoff HJ, Niermeijer P, Gips CH, et al: Hepatic morphologic findings and viral antigens in acute hepatitis B. Virchows Arch A Pathol Anat Histol 389:153–166, 1980.PubMedCrossRefGoogle Scholar
  54. 54.
    Dietrichson O, Juhl T, Christoffersen P, et al: Acute viral hepatitis: Factors possibly predicting chronic liver disease. Acta Pathol Microbiol Scand A 83:183–188, 1975.PubMedGoogle Scholar
  55. 55.
    Vanstapel MJ, van Steenbergen W, de Wolf-Peeters C, et al: Prognostic significance of piecemeal necrosis in acute viral hepatitis. Liver 3:46–57, 1983.PubMedGoogle Scholar
  56. 56.
    Sherlock S. Predicting progression of acute type-B hepatitis to chronicity. Lancet 2:354–356, 1976.PubMedCrossRefGoogle Scholar
  57. 57.
    Milich DR, Chisari FV: Genetic regulation of the immune response to hepatitis S surface antigen (HBsAg). I. H-2 restriction of the murine humoral immune response to the a and d determinants of HBsAg. J Immunol 129:320–325, 1982.PubMedGoogle Scholar
  58. 58.
    Milich DR, Leroux-Roels GG, Chisari FV, et al: Genetic regulation of the immune response to hepatitis S surface antigen (HBsAg). IV. Distinct H-2 linked Ir genes control antibody responses to different HBsAg determinants on the same molecule and map to the I-A and I-C subregions. J Exp Med 159:41–56, 1984.PubMedCrossRefGoogle Scholar
  59. 59.
    Milich DR, Peterson DL, Chisari FV: Comparison of S cell and S cell immune recognition of HBsAg, in Vyas GN, Dienstag JL, Hoofnagle JH (eds): Viral Hepatitis and Liver Disease. Grune & Stratton, Orlando, Florida, 1984, pp. 573–582.Google Scholar
  60. 60.
    Kennedy RC, Adler-Storthz K, Henkel RD, et al: Immune response to hepatitis S surface antigen: Enhancement by prior injection of antibodies to the idiotype. Science 221:853–855, 1983.PubMedCrossRefGoogle Scholar
  61. 61.
    Kennedy RC, Melnick JL, Dreesman GR: Antibody to hepatitis S virus induced by injecting antibodies to the idiotype. Science 223:930–931, 1984.PubMedCrossRefGoogle Scholar
  62. 62.
    Chisari FV: Regulation of lymphocyte function and viral transformation by hepatic bioregulatory molecules. Hepatology 2(suppl):97S–106S, 1982.Google Scholar
  63. 63.
    Dienstag JL: Immunologic mechanisms in chronic viral hepatitis, in Vyas GN, Dienstag JL, Hoofnagle JH (eds): Viral Hepatitis and Liver Disease. Grune & Stratton, Orlando, Florida, 1984, pp. 135–166.Google Scholar
  64. 64.
    Davis GL, Hoofnagle JH: Reactivation of chronic hepatitis S virus infection. Gastroenterology 92:2028–2031, 1987.PubMedGoogle Scholar
  65. 65.
    Liaw Y-F, Pao CC, Chu C-M, et al: Changes of serum hepatitis S virus DNA in two types of clinical events preceding spontaneous hepatitis S e antigen seroconversion in chronic type S hepatitis. Hepatology 7:1–3, 1987.PubMedCrossRefGoogle Scholar
  66. 66.
    Realdi G, Alberti A, Rugge M, et al: Seroconversion from hepatitis S e antigen to anti-HBe in chronic hepatitis S virus infection. Gastroenterology 79:195–199, 1980.PubMedGoogle Scholar
  67. 67.
    Hoofnagle JH, Dusheiko GM, Seeff LB, et al: Seroconversion from hepatitis S e antigen to antibody in chronic type S hepatitis. Ann Intern Med 94:744–748, 1981.PubMedGoogle Scholar
  68. 68.
    Liaw YF, Chu CM, Su IJ, et al: Clinical and histological events preceding hepatitis S e antigen seroconversion in chronic type S hepatitis. Gastroenterology 84:216–219, 1983.PubMedGoogle Scholar
  69. 69.
    Popper H: Changing concepts of the evolution of chronic hepatitis and the role of piecemeal necrosis. Hepatology 3:758–762, 1983.PubMedGoogle Scholar
  70. 70.
    Kerr JF, Cooksley WGE, Searle J, et al: The nature of piecemeal necrosis in chronic active hepatitis. Lancet 2:827–828, 1979.PubMedCrossRefGoogle Scholar
  71. 71.
    Baggenstoss AJ, Summerskill WHK, Ammon HV: The morphology of chronic hepatitis, in Schaffner F, Sherlock S, Leevy CM (eds): The Liver and Its Diseases. Intercontinental Medical Book, New York, 1974, pp. 199–206.Google Scholar
  72. 72.
    Popper H, Schaffner F: Chronic hepatitis: Taxonomic, etiology and therapeutic problems, in Popper H, Schaffner F (eds): Progress in Liver Diseases. Grune & Stratton, Orlando, Florida, 1977, pp. 531–558.Google Scholar
  73. 73.
    Popper H, Schaffner F: The vocabulary of chronic hepatitis. S Engl J Med 284:1154–1156, 1971.CrossRefGoogle Scholar
  74. 74.
    De Groote J, Desmet VJ, Gedigk P, et al: A classification of chronic hepatitis. Lancet 2:626–628, 1968.PubMedCrossRefGoogle Scholar
  75. 75.
    Ludwig J: A review of lobular, portal and periportal hepatitis. Hum Pathol 8:269–276, 1977.PubMedCrossRefGoogle Scholar
  76. 76.
    Scheuer PJ: Liver biopsy in chronic hepatitis: 1968-1978. Gut 19:554–557, 1978.PubMedCrossRefGoogle Scholar
  77. 77.
    Christofferson P, Dietrichson O: Histological changes in liver biopsies from patients with chronic hepatitis. Acta Pathol Microbiol Scand A 82:539–546, 1974.Google Scholar
  78. 78.
    Scheuer PJ: Chronic hepatitis. A problem for the pathologist. Histopathology 1:5–19, 1977.PubMedCrossRefGoogle Scholar
  79. 79.
    Boyer JL, Klatskin G: Pattern of necrosis in acute viral hepatitis. Prognostic value of bridging (subacute hepatic) necrosis. S Engl J Med 283:1063–1071, 1970.CrossRefGoogle Scholar
  80. 80.
    Boyer JL: The diagnosis and pathogenesis of clinical variants in viral hepatitis. Am J Clin Pathol 65:898–908, 1976.PubMedGoogle Scholar
  81. 81.
    Bianchi L: Acute viral hepatitis S with bridging necrosis: A follow-up study. Liver 1:222–229, 1981.PubMedGoogle Scholar
  82. 82.
    Ware AJ, Eigenbrodt EH, Combes B: Prognostic significance of subacute hepatic necrosis in acute hepatitis. Gastroenterology 68:519–524, 1975.PubMedGoogle Scholar
  83. 83.
    Baggenstoss AH, Soloway RD, Summerskill WHS, et al: Chronic active liver disease, the range of histologie lesions, their response to treatment and evolution. Hum Pathol 3:183–198, 1972.PubMedCrossRefGoogle Scholar
  84. 84.
    Dienes HP, Purcell RH, Popper H, et al: Simultaneous infection of chimpanzees with more than one hepatitis virus. Hepatology 1:506, 1981. (abst).Google Scholar
  85. 85.
    Marmion BP, Burrell CJ, Tonkin RW, et al: Dialysis-associated hepatitis in Edinburgh, 1969-1978. Rev Infect Dis 4:619–637, 1982.PubMedCrossRefGoogle Scholar
  86. 86.
    Popper H, Thung SN, Gerber, MA, et al: Histologic studies of severe delta infection in Venezuelan Indians. Hepatology 3:906–912, 1983.PubMedCrossRefGoogle Scholar
  87. 87.
    Rizzetto M: The delta agent. Hepatology 3:729–737, 1983.PubMedCrossRefGoogle Scholar
  88. 88.
    Liaw YF, Tai DI, Chu C-M, et al: Acute exacerbation in chronic type S hepatitis: Comparison between HBeAg and antibody-positive patients. Hepatology 7:20–23, 1987.PubMedCrossRefGoogle Scholar
  89. 89.
    Perrillo RP, Campbell CR, Sanders GE, et al: Spontaneous clearance and reactivation of hepatitis S virus infection among male homosexuals with chronic type S hepatitis. Ann Intern Med 100:43–46, 1984.PubMedGoogle Scholar
  90. 90.
    Lok AS, Lai C-L, Wu P-C, et al: Spontaneous hepatitis S e Antigen to antibody seroconversion and reversion in Chinese patients with chronic hepatitis S virus infection. Gastroenterology 92:1839–1843, 1987.PubMedGoogle Scholar
  91. 91.
    Gerber MA, Thung SN: The diagnostic value of immunohistochemical demonstration of hepatitis viral antigens in liver. Hum Pathol 18:771–774, 1987.PubMedCrossRefGoogle Scholar
  92. 92.
    Chu CM, Liaw YF: Intrahepatic distribution of hepatitis S surface and core antigen s in chronic hepatitis S virus infection. Gastroenterology 92:220–225, 1987.PubMedGoogle Scholar
  93. 93.
    Omata M, Yokosuka O, Imazeki F, et al: Correlation of hepatitis S virus DNA and antigens in the liver. A study in chronic liver disease. Gastroenterology 92:192–196, 1987.PubMedGoogle Scholar
  94. 94.
    Brechot C, Scotto J, Charnay P, et al: Detection of hepatitis S virus DNA in liver and serum: a direct appraisal of the chronic carrier state. Lancet 2:765–770, 1981.PubMedCrossRefGoogle Scholar
  95. 95.
    Hoofnagle JH, Dusheiko GM, Seeff LB, et al: Seroconversion from hepatitis S e antigen to antibody in chronic type S hepatitis. Ann Intern Med 94:744–748, 1981.PubMedGoogle Scholar
  96. 96.
    Realdi G, Alberti A, Ruzzi M, et al: Seroconversion from HBe antigen to anti-HBe in chronic HBV infection. Gastroenterology 79:195–199, 1980.PubMedGoogle Scholar
  97. 97.
    Becker MD, Baptista A, Scheuer PJ, et al: Prognosis of chronic persistent hepatitis. Lancet 1:53–57, 1970.PubMedCrossRefGoogle Scholar
  98. 98.
    Gerber MA, Vernace S: Chronic septal hepatitis. Virchows Arch A Pathol Anat Histol 363:303–309, 1973.CrossRefGoogle Scholar
  99. 99.
    Kam W, Rall LB, Smuckler EA, et al: Hepatitis S viral DNA in liver and serum of asymptomatic carriers. Proc Natl Acad Sci USA 79:7522–7526, 1982.PubMedCrossRefGoogle Scholar
  100. 100.
    Lieberman HM, LaBrecque DR, Kew MC, et al: Detection of hepatitis S virus DNA directly in human serum by a simplified molecular hybridization test: Comparison to HBeAg anti-HBe status in HBsAg carriers. Hepatology 3:285–291, 1983.PubMedCrossRefGoogle Scholar
  101. 101.
    Scotto J, Hadchouel M, Hery C, et al: Detection of hepatitis S virus DNA in serum by a simple spot hybridization technique: Comparison with results for other viral markers. Hepatology 3:279–284, 1983.PubMedCrossRefGoogle Scholar
  102. 102.
    Nowoslawski A, Krawczynski K, Nazarewicz T, et al: Immunopathological aspects of hepatitis type B. Am J Med Sci 270:229–239, 1975.PubMedCrossRefGoogle Scholar
  103. 103.
    Chisari FV, Edginton TS, Routenberg JA, et al: Cellular immune reactivity in HBV-induced liver disease, in Vyas GN, Cohen SN, Schmid R (eds): Viral Hepatitis. The Franklin Institute Press, Philadelphia, 1978, pp. 245–266.Google Scholar
  104. 104.
    Craxi A, Montano L, Goodall A, et al: Genetic and sex-linked factors influencing HBs antigen clearance. I. Nonimmune clearance in inbred strains of mice. J Med Virol 9:117–123, 1982.PubMedCrossRefGoogle Scholar
  105. 105.
    Tassopoulos N, Papaevangelou GZ, Sjögren SS, et al: A: Natural History of acute hepatitis S surface antigen-positive hepatitis in Greek adults. Gastroenterology 92:1844–1850, 1987.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Michael A. Gerber
    • 1
  1. 1.Department of PathologyTulane University School of MedicineNew OrleansUSA

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