(anti-HB5 and anti-HBc) in fulminant hepatitis: pathogenic and prognostic significance1

Hepatitis B surface antigen (HBsAg) and antibodies to both the surface and core antigens of the hepatitis B virus (anti-HBs and anti-HBc) have been studied in 64 consecutive cases of fulminant hepatitis. HBsAg was detected by counterelectrophoresis in 23 (35-9 %) but by radioimmunoassay in 38 (59-3 %). Anti-HBs was detected by passive haemagglutination in 26 (40-6 %), coexisting HBsAg and anti-HBs were found in 16 cases (25 %). Using an indirect immunofluorescence technique, anti-HBc was found in all of the cases in whom either HBsAg or anti-HBs was present. The highest survival rate was observed in patients with no evidence ofHBV infection (31-3%) and was lowest in those who had both HBsAg and anti-HBs detected simultaneously (6-2 %). The prognosis of those who exhibited anti-HBs only was no better than those with HBsAg alone. In a further case, transient interruption of the asymptomatic chronic HBsAg carrier state with seroconversion to anti-HBs was associated with the development of a fulminant hepatitis syndrome. The results suggest that an unusually strong and rapid immune clearance of HBsAg may be involved in the pathogenesis of fulminant hepatitis.