title: Liver histology and immunohistochemical findings in asymptomatic Indians with incidental detection of hepatitis B virus infection.
abstract: OBJECTIVE
  The relationship between hepatocyte expression of hepatitis B virus (HBV) antigens, liver histology and viral replication in asymptomatic subjects with incidental detection of hepatitis B surface antigen (HBsAg) remains unclear. We evaluated the histological activity index (HAI) and hepatocyte expression of viral antigens with replicative status in asymptomatic chronic HBV infection.
  
  
  METHODS
  Asymptomatic subjects with incidental detection of HBsAg and ALT levels less than twice the upper limit of normal were grouped as follows: Group A - negative for HBeAg and HBV DNA (no HBV replication); B - HBeAg negative, HBV DNA positive (low HBV replication or pre-core mutant); C - positive HBeAg and HBV DNA (high viral replication). Liver biopsies were assessed for HAI (Ishak's scoring system). These were also subjected to immunohistochemistry for expression of HBsAg and hepatitis B core antigen (HBcAg); distribution, staining pattern and quantitative measurement of antigen expression were assessed.
  
  
  RESULTS
  Median HAI was similar in the three groups (1.0, 2.0 and 2.0 in groups A, B and C, respectively). All subjects in Group C showed discrete cytoplasmic expression of HBsAg, whereas the other two groups showed heterogeneity in distribution and pattern of HBsAg staining. Quantitative measurement of cytoplasmic HBsAg revealed similar results in the three groups. Core antigen (nuclear) was detected in 4 of 5 subjects in Group C and none of those in Groups A and B. Ground-glass hepatocytes were seen in 20 and orcein-positive cells in 26 cases. HBsAg was detected by immunohistochemistry in 37 biopsies.
  
  
  CONCLUSIONS
  Among asymptomatic subjects with chronic HBV infection, those with high rate of viral replication had discrete cytoplasmic HBsAg expression and nuclear expression of core antigen; these findings were uncommon in subjects with low or no viral replication.
authors.affiliation: Department of GI Sciences, Christian Medical College and Hospital, Vellore - 632 004, India. ashis@cmcvellore.ac.in
authors.forename: Ashis
authors.initials: A
authors.lastname: Mukhopadhya
authors.forename: Banumathi
authors.initials: B
authors.lastname: Ramakrishna
authors.forename: Vijay
authors.initials: V
authors.lastname: Richard
authors.forename: Rajiv
authors.initials: R
authors.lastname: Padankatti
authors.forename: C E
authors.initials: CE
authors.lastname: Eapen
authors.forename: George M
authors.initials: GM
authors.lastname: Chandy
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000378:metabolism; D005260:Female; D006512:Hepatitis B Core Antigens / Q000378:metabolism; D006514:Hepatitis B Surface Antigens / Q000378:metabolism; D006515:Hepatitis B virus / Q000276:immunology / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000473:pathology; D022781:Hepatocytes / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D033162:Incidental Findings; D008099:Liver / Q000473:pathology* / Q000821:virology; D008297:Male; D012680:Sensitivity and Specificity; D014779:Virus Replication
chemical_list: D015415:Biomarkers; D004279:DNA, Viral; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D000410:Alanine Transaminase