73

"MINIMAL CHANGES" ARE NOT IN CONTRAST WITH THE CONCEPT OF HBsAg HEAL

THY CARRIER.

L. Corbosiero, M. De Caprio, M. Melito, E. Di Vaia.

U.S.L. 42, Ospedale Elena D'Aosta, Napoli, II Div. Medicina Generale.

AntiHBc response is always valid in all HBsAg carriers and it is proportionate to

the quantity of "bare" HBcAg deriving from hepatic cytolysis. AntiHBs response, instead,

is absent in HBsAg healthy carriers and scarce in HBsAg ill carriers, in which lastitis

masked by immunocomplexes. So we can consider HBsAg the principal antigen involved in

the immunologic cytolysis and the pathogenesis of hepatocytolysis as "specific" if it

is dependent on membrane HBsAg; this localizat'ion is by now acknowledged in all HBsAg

cdrriers, strengthening so the pathogenesis as a lack of cell-mediated response to HBsAg

(healthy carriers) or as a shortage of the same response (ill carriers). As immune response

genetically determined, especially as regards its quantity, there is a certain parallelism

between the quantity of humoral and cell-mediated immune response to a given antigen.

So "minimal changes" found in healty carriers come from membrane HBcAg or HBeAg only,

<md from humoral response (respective antibodies) + cell-mediated response (K-cells:

ADDCC), or from cell-mediated responses through specific CTL for these two last antigens

,~ from NK-cells, or from "armed" macrophages.

TISSUE MARKERS OF HBV AND HDV: DO THEY INCREASE DIAGNOSTIC ACCURACY?

A.CRAXI', M.VINCI, V.DI MARCO, L.PAGLIAR0. CLINICA MEDICA (R)-PALERMO, ITALY. 74

Patients with chronic HBV infection are usually classified according to HBeAg and

~nti-HD status into high HBV replieators or non-replieators and as HDV-infected or uninfected.

I'his bears prognostic significance.Since tissue HBcAg has been shown to be strictly related

i,, HBV-DNA(Lok et al.Gut 25,1283,1984) and since not all anti-HD positive subjects have acti-

v.. HDV infection,we have evaluated the increase in accuracy provided by immunohistolop~y in

D%3 consecutive HBsAg positive subjects with chronic liver disease biopsied for diagnostic

p,~rposes.lmmunoflorescence was performed on cryostat section, using FITC-conjugated human anti-

t{Be a n d anti-HD.

tIBV rep]icators, HDV uninfected

HBV non-rep]icators, HDV uninfected

i]BV replicators, NDV infected

}IBV non-replieators, HDV infected

SEROLOGY TISSUE

(HBeAg,anti-HD) (HBcAg,HDAg)

24.4% 33%

41.7% 36.9%

1.9% 2.9%

32% 27.2%

Fi:;sue HBcAg revealed HBV replication i n 17% of HBeAg negative subjects. Presence of anti-HD

¢;~s not related to active HDV infection,as expressed by tissu~ HDAg,in 11.4% of anti-HD posi-

Tive patients. Immunohystolop=~y i~ thus a simple and useful additional tool in the diagnosis

of HBsAg positive chronic liver disease.

S215