[The clinical significance of negative serological markers of hepatitis B infection in hepatitis B virus carriers with chronic hepatic disease].

OBJECTIVE

To assess the clinical significance of cases who were negative for hepatitis B serological markers but were found incidently to be HBV carriers with HBV replicative infection.

METHODS

In 12 out of the 50 biopsy proved cases, the hepatitis B serological markers and anti-HCV were all negative and ALT level also normal in repeated assays. Serum HBV DNA and HCV RNA of all the cases were analysed by PCR. Liver specimens were examined by immunohistochemistory for HBsAg and HBcAg. The pathological changes were classified into 4 grades and 4 stages, and Knodell HAI was also recorded.

RESULTS

Five cases initially diagnosed as HBV carriers showed high viral replication (4 cases had loads of 10(4) approximately 10(5) copies/ml, the other 1 had < 10(4) copies/ml). The periportal and/or intralobular inflammation and fibrosis were G1 and S1. The virus load of the 4 cases initially suspected of chronic hepatitis were even higher (2 case > 10(6) copies/ml, 2 case > 10(5) copies/ml). On the contrary, 3 cases initially suspected of liver cirrhosis showed low replication (all less than 10(4) copies/ml), but their histologic changes were more advanced, 2 cases of G4 and S4, 1 case of G3 and S4. Their HAI were 17, 17 and 11, respectively.

CONCLUSIONS

HBV carriers with normal level of ALT and negative serological HBV markers are not very uncommon. They often have a high replicative infection. Some of the chronic hepatitis patients with normal ALT and negative serological HBV markers have more active viral replication. The clinical significance of this kind of patients should not be underestimated. It may be the cause of some cases of cryptogenic cirrhosis and hepatocellular carcinoma of unknown etiology.