A long-term follow-up study of asymptomatic hepatitis B surface antigen-positive carriers in Montreal.
OBJECTIVE
Prospective studies from the Far East and Alaska have shown an increased mortality from cirrhosis and/or hepatocellular carcinoma in asymptomatic hepatitis B virus (HBV) carriers. The magnitude of this risk in apparently healthy North American carriers remains undefined.


METHODS
The outcomes of 317 asymptomatic hepatitis B surface antigen-positive carriers from the Montreal area were examined after 16 years of follow-up. A majority of carriers were of French Canadian origin, were positive for antibody to hepatitis B e antigen, and had normal serum transaminase levels; institutionalization in orphanages as infants or children was the most important epidemiological risk factor, suggesting horizontal transmission of HBV during childhood.


RESULTS
At follow-up, mean age was 46 +/- 8 years; 3 carriers had died of HBV-related cirrhosis, 1 of alcoholic cirrhosis, and 9 of causes unrelated to liver disease. No carrier died of hepatocellular carcinoma; had the risk of hepatocellular carcinoma been similar to that reported from the Far East and Alaska, 17 cases of hepatocellular carcinoma-related deaths would have been expected. During follow-up, the annual negativation rate for hepatitis B surface antigen was 0.7%.


CONCLUSIONS
In asymptomatic HBV carriers from Montreal, a majority are "healthy" carriers and remain asymptomatic after 16 years of follow-up and the risk of death from HBV-related cirrhosis and/or hepatocellular carcinoma is low.
Villeneuve
J P
JP
Department of Medicine, Hôpital Saint-Luc, Montreal, Canada.
Desrochers
M
M
Infante-Rivard
C
C
Willems
B
B
Raymond
G
G
Bourcier
M
M
Côté
J
J
Richer
G
G
D000328:Adult; D000937:Antigen-Antibody Reactions; D002170:Canada; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology; D002353:Carrier State / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors
D006514:Hepatitis B Surface Antigens