Acute Viral Hepatitis, Types A, B and Non-A, Non-B: A Prospective Study of the Epidemiological, Laboratory and Prognostic Aspects in 280 Consecutive Cases

Abstract

Between September 1977 and October 1978, 280 consecutive cases of acute viral hepatitis in 276 patients (mean age 30.6, range 4–78 years) were seen at a Stockholm hospital for infectious diseases. Serial serum specimens were tested for hepatitis-B surface antigen (HBsAg), and the corresponding antibody (antiHBs); antibody against hepatitis-B core antigen (antiHBc); hepatitis-B e antigen (HBeAg) and the corresponding antibody (antiHBc), and antibodies against hepatitis-A virus (antiHAV) of the IgG and IgM classes. Hepatitis A (HA) was diagnosed in 84 cases (30%), hepatitis B (HB) in 129 cases (46%) and, by exclusion, hepatitis non-A, non-B (NANB) in 63 cases (23%). Four patients had 2 ***consecutive episodes of hepatitis, 2 with HA followed by HB and 2 with HB followed by NANB. Frequently noted epidemiological data of possible significance for viral transmission were, for HA patients, visits abroad (42%) and contacts with a known case of hepatitis (29%) and, for NANB patients, drug addiction (41%) and visits abroad (29%). HB, on the other hand, was as often associated with visits abroad (29%) as with drug addiction (30%) and with contacts with a case of hepatitis (26%). Biochemical investigations showed that HB had a significantly higher, maximum, serum alanine-aminotransferase (S-ALAT) value than HA and NANB (p<0.001 in both). HA and HB had significantly higher, maximum, S-bilirubin values than NANB (p<0.001 in both). HA had a significantly higher, maximum, S-alkaline phosphatase (S-ALP) value than HB (p<0.001) and NANB (p<0.01) and also a significantly higher, maximum IgM value than HB and NANB (p<0.001 in both). In many cases, however, neither epidemiology nor considerations based on biochemical results could differentiate the various types of hepatitis. At the 3-month follow-up, the S-ALAT values were normalised in 67% of the HA cases and in 65% of the NANB cases but in 89% of the HB cases. At 6 months, the corresponding rates were 93%, 71% and 96%, respectively. 2% of patients with HB and not less than 25% of those with NANB progressed to chronic hepatitis.