Interplay of cell and serum immunologic markers in chronic persistent or active hepatitis B

Immunologic markers associated with hepatitis B virus (HBV) infection (HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, anti-delta) were tested by radioimmunoassay of serum from chronic hepatitis patients. The corresponding liver biopsy samples were examined for the presence of HBsAg, HBcAg, and delta antigen in the cells by direct immunofluorescence and by electron microscopy. Seventy patients were selected for the presence of both circulating HBsAg and anti-HBc. Comparison of chronic persistent (CPH) and chronic active (CAH) hepatitis showed a significantly greater frequency of intracytoplasmic HBsAg in CPH, especially in the absence of intranuclear HBsAg, and a greater frequency of intranuclear delta antigen and/or circulating anti-delta in CAH. The delta/anti-delta system was almost systematically associated with serum anti-HBe. At variance with HBeAg/anti-HBe, delta/anti-delta found significantly more frequently in patients originating from Southern rather than from Northern or Central Italy. The prevalence of both these immunologic systems was related to the age of the patients.