Clinical presentation and natural history of chronic persistent hepatitis. A multicentre retrospective study on 1197...

To obtain data on the clinical presentation and the course of the disease of biopsy-proven chronic persistent hepatitis (CPH), we coordinated a multicentre retrospective study on 1197 patients observed in 16 liver units throughout Italy from 1975 to 1985. Most patients were asymptomatic and CPH was often diagnosed either after a chance finding of liver enlargement, or increased serum aminotransferases and/or HBsAg antigenemia. Of the 1197 patients, 534 (44.6%) were HBsAg-positive and 663 (55.4%) were HBsAg-negative. HBeAg was tested in 356 of the 534 positive cases and detected in 58.4% of them. This percentage was higher (80%) in patients under 20. Hepatitis delta virus infection (HD-Ag in liver tissue and/or anti-HD in serum) was detected in 28 (14.7%) of the 191 patients tested on presentation. Liver function tests showed mild hepatic involvement in both HBsAg-positive and negative cases, a pronounced derangement being observed only in patients with HDV infection. A second liver biopsy was performed in 212 patients (144 HBsAg positive and 68 HBsAg negative) and the outcome of the disease was evaluated only in these 212 patients. Of the 144 HBsAg-positive cases followed-up from one to ten years (median 4 years), 47 recovered, 70 remained unchanged and 27 developed chronic active hepatitis or cirrhosis. Clearance of HBsAg was uncommon even in patients who recovered. Being under 15 years of age favourably affected the course of the disease, while HDV infection was correlated to an unfavourable outcome. Among those patients who were HBeAg positive on presentation and who underwent a second affect the outcome. Of the 68 HBsAg-negative clearly affect the outcome.(ABSTRACT TRUNCATED AT 250 WORDS)