The diagnostic and prognostic value of pre-S(1)Ag and pre-S(2)Ab was investigated in 69
HBsAg surface antigen positive patients--14 with acute
hepatitis B, 30 with chronic
liver disease (six
chronic persistent hepatitis, 14
chronic active hepatitis, 10 with
cirrhosis) and in 25 asymptomatic carriers. Pre-S(1)Ag was found in all patients with
chronic hepatitis B virus (HBV)
infection regardless of viral replication. In contrast, pre-S(2)Ab was not detected in any patients. Acute
hepatitis was studied sequentially with periodic controls at 20 day intervals. Pre-S(1)Ag cleared before
HBsAg in six of 14 (43%) patients who progressed favourably, and the two
antigens cleared simultaneously in eight of 14 (57%) cases. Patients with early clearance of pre-S(1)Ag progressed favourably, thus indicating the prognostic value of this test, which, however, is still of limited practical application given the small temporal difference between the moment of clearance of the two
antigens. The first markers to clear, however, were
HBeAg and
DNA-HBV, which showed significant differences with respect to the clearance of
HBsAg. Moreover, pre-S(2)Ab appeared before HBsAb in 57.1% of our patients and was found in some patients before pre-S(1)Ag and
HBsAg had cleared (42.8%), thus allowing complete viral clearance and acute HBV
infection to be predicted earlier.