Parvovirus B19 has been associated by some investigators with cases of severe hepatitis. The aim of the present study was to determine the presence of active parvovirus B19 infection among 129 Brazilian patients with non-A-E hepatitis. The patients were assayed for antibodies against parvovirus B19, IgM class, by ELISA. In IgM-positive cases, parvovirus B19 DNA was assayed by PCR in serum and liver tissue and parvovirus VP1 antigen in liver tissue was assayed by immunohistochemistry. Antibodies against parvovirus B19, IgM class, were detected in 3 (2.3%) of 129 patients with non-A-E hepatitis. Previous surgery and blood transfusions were reported by these 3 patients. One patient was a 56-year-old female with severe hepatitis, with antimitochondrial antibody seropositivity and submassive necrosis at liver biopsy, who responded to corticosteroid therapy. Strong evidence for active parvovirus B19 infection was found in this patient, with parvovirus B19 DNA being detected by PCR in liver tissue. Furthermore, parvovirus VP1 antigen was also detected in liver tissue by immunohistochemistry. The other two IgM-positive patients were chronic hepatitis cases, but active infection was not proven, since neither viral DNA nor antigen were detected in their liver tissues. This and other reports suggest a possible relation between parvovirus B19 infection and some cases of hepatitis.

A resposta ao tratamento com interferon em pacientes com hepatite crônica NANB/C tem sido classificada como completa, parcial ou ausente, de acordo com o comportamento da alanino aminotransferase sérica (ALT). Entretanto, uma observação mais detalhada da atividade enzimática tem mostrado que os padrões podem ser mais complexos. O objetivo deste estudo foi descrever o seguimento tardio e os padrões de resposta da ALT em pacientes com hepatite crônica NANB/C tratados com interferon alfa recombinante. Classificamos os tipos de resposta da ALT em 6 padrões e as freqüências observadas foram:I. Resposta completa e persistente = 9 (20,5%); II. Resposta completa com recaída persistente após o IFN = 7 (15,9%); III. Resposta completa com recaída temporária = 5 (11,9%); IV. Normalização temporária e recaída durante o tratamento com IFN = 4 (9,1%); V. Resposta parcial (queda dos níveis iniciais da ALT maior que 50%) = 7 (15,9%); VI. Não resposta = 12 (27,3%). Em conclusão, os padrões de ALT variam durante e após o tratamento e podem ser classificados em pelo menos 6 tipos.

The response to interferon treatment in chronic hepatitis NANB/C has usually been classified as complete, partial or absent, according to the behavior of serum alanine aminotransferase (ALT). However, a more detailed observation of the enzymatic activity has shown that the patterns may be more complex. The aim of this study was to describe the long term follow-up and patterns of ALT response in patients with chronic hepatitis NANB/C treated with recombinant interferon-alpha. A follow-up of 6 months or more after interferon-a was achieved in 44 patients. We have classified the serum ALT responses into six patterns and the observed frequencies were as follows: I. Long term response = 9 (20.5%); II. Normalization followed by persistent relapse after IFN = 7 (15.9%); III. Normalization with transient relapse = 5 (11.9%); IV. Temporary normalization and relapse during IFN = 4 (9.1%); V. Partial response (more than 50% of ALT decrease) = 7 (15.9%); VI. No response = 12 (27.3%). In conclusion, ALT patterns vary widely during and after IFN treatment and can be classified in at least 6 types.

A detecção do DNA do Vírus da Hepatite B pela Reação em Cadeia da Polimerase (PCR) foi comparada com os outros marcadores sorológicos virais (AgHBs, AgHBe e anti-HBe) numa série de 49 pacientes com hepatite crônica B, incluindo 12 que apresentaram clareamento espontâneo do AgHBs. Nenhum caso AgHBs negativo foi PCR positivo, mas 33/37 (89,2%) dos casos AgHBs positivos foram PCR positivos (p < 0,0001). Entre as amostras AgHBs positivas, 9 foram AgHBc positivas e anti-HBe negativas, todas elas PCR positivas. Outros 3 pacientes foram AgHBe e anti-HBe positivos, todos também PCR positivos. Um terceiro grupo incluía 21 pacientes anti-HBe positivos e anti-HBe negativos: 19 foram PCR positivos e 2 PCR negativos. Os últimos 4 casos foram AgHBe e anti-HBe negativos, sendo 2 destes PCR positivos. A detecção de casos virêmicos anti-HBe positivos sugere que as variantes preC do VHB podem também estar presentes em nosso país. Em conclusão, a "fase de integração viral" da hepatite crônica B parece ser muito menos frequente do que se imaginava previamente, quando apenas se dispunha das técnicas de detecção de AgHBe e DNA por hibridização. O novo termo "fase de baixa replicação baixa" parece ser melhor que o anterior "fase de integração viral" .

Detection of HBV-DNA by PCR was compared with other serological markers (HBsAg, HBeAg and anti-HBe) in a series of49 Chronic Hepatitis B patients, including 12 with a spontaneous clearance of HBsAg. None of these HBsAg negative cases were PCR positive, but 33/37 (89.2%) HBsAg positive cases were PCR positive (p < 0.0001). Among HBsAg positive samples, nine cases were HBeAg positive and anti-HBe negative, all of them PCR positive. Other 3 patients were HBeAg and anti-HBe positive and these cases were also found PCR positive. A third group included 21 patients anti-HBe positive and HBeAg negative: 19 of them were PCR positive and 2 were PCR negative. The last 4 cases were HBeAg and anti-HBe negative, two of them were PCR positive. The detection of anti-HBe viremic cases in the present series suggest that preC variants could occur in our country. In conclusion, the integrated phase o f chronic hepatitis B seems to be less frequent than it was assumed, when only HBeAg or dot blot hybridization techniques were used. The new term "low replication phase" might favorably replace the former "integrated phase".