Liver Disease in Asymptomatic Carriers of Hepatitis B Antigen

The hepatic status of apparently healthy hepatitis B antigen (HB Ag) carriers is controversial. To help clarify this issue we did a prospective study of 6277 Red Cross blood donors in Canada. Of these, nine were chronic HB Ag carriers, with neither symptoms nor signs of hepatic or other disease. All were young adults who either abused drugs or had lived abroad where antigenemia is more prevalent than in North America. Liver function tests were mildly or moderately deranged in seven of the nine. Liver biopsy from each carrier was coded, randomly mixed with dummy biopsies, and read blindly by both authors. All biopsies were abnormal: nonspecific focal or reactive hepatitis was present in six, active lobular inflammation typical of acute viral hepatitis was present in one, and chronic aggressive hepatitis was present in two. Serial biopsies in a tenth asymptomatic HB Ag carrier, who was not part of the above prospective series, showed transition from active lobular hepatitis to chronic persistent hepatitis during a 13-mo period. We conclude that a wide spectrum of subclinical hepatic disease regularly accompanies the asymptomatic HB Ag carrier state in Canada.