HEPATITIS-B ANTIGEN, ANTIGEN SUBTYPES, AND HEPATITIS-B ANTIBODY IN NORMAL SUBJECTS AND PATIENTS WITH LIVER-DISEASE - RESULTS OF A COLLABORATIVE STUDY

Abstract

The relative sensitivities of counterimmunoelectrophoresis (CIE) and hemagglutination assays for the detection of hepatitis B surface antigen (HBsAg) and antibodies (anti-HBs) were compared. Scientists from 10 countries in Asia, Africa and the Pacific region participated in the study. The participants provided serum samples from 15,953 subjects comprising patients with acute and chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC), as well as blood donors and other normal individuals. For the detection of HBsAg in a reference panel serum, immune adherence hemagglutination (IAHA) was slightly more sensitive than passive hemagglutination inhibition (PHI); CIE was the least sensitive. Mean HBsAg frequencies in patients with acute hepatitis, chronic hepatitis, cirrhosis, and HCC were significantly higher than in healthy controls. Passive hemagglutination (PHA) was more sensitive than CIE for the detection of anti-HBs The frequency of anti-HBs in patients with HCC was significantly lower than that in the other groups. Mean anti-HBs frequencies in patients with acute hepatitis, chronic hepatitis, and cirrhosis were not significantly different from that in normal subjects. Subtyping of HBsAg was performed by PHI. Among asymptomatic carriers the predominant HBsAg subtype in northeast Asia was adr. In India, ayw predominated in carriers, with the demarcation between adr and ayw occurring west of Burma. In W Africa the only subtype detected was ayw, but in E Africa the majority subtype was adw. The r subtype was found only in Asian populations east of India and in Western Pacific populations. In Papua New Guinea, all 4 subtypes were identified. With 1 possible exception, the subtypes of HBsAg-positive patients with liver disease reflected the predominant type in each geographic location.