HEPATITIS-B VIRUS-INFECTION IN SCHISTOSOMIASIS-MANSONI

Schistosomiasis and hepatitis B virus (HBV) infection are very common in Brazil but the interrelationships between the two infections are po orly understood. We have undertaken a detailed serological study of th e prevalence of HBV markers in 189 Brazilian patients with chronic sch istosomiasis mansoni, 46 with hepatointestinal (HIS) and 143 with hepa tosplenic (HSS) schistosomiasis, 12 of the latter having decompensated liver disease (HSSD), and in 50 control patients. Sera were tested fo r HBsAg, anti-e, antiHBc, anti-HBs and HBV-DNA. Eighty-three (44%) of the 189 schistosoma patients had at]east one marker of HBV infection, 18 of whom (10%) were seropositive for HBsAg. All the controls were Hb sAg negative, but ten (20%) had anti-HBc and anti-HBs. There was no si gnificant difference in the frequency of these markers between HIS (14 / 46, 30.4%), HSSC (43/131, 34.5%), and the con trols. Among the HBsAg -positive patients, one had HIS (HBV-DNA negative), seven had HSSC (on e HBV-DNA positive) and ten had HSSD (six HBV-DNA positive), a signifi cant association of HBV carriage with HSSD (P much less than 0.001). M ean (+/- SD) ALT values were significantly (P < 0.001) higher in HBsAg -positive HSSD patients (70.7 +/- 18 IU/liter) than in those with HSSC (29.5 +/- 15 IU/liter). Liver biopsies were performed in 12 HBsAg-pos itive patients (one with HIS, three with HSSC, and eight with HSSD) an d in 50 HBsAg-negative HSSC patients. Seven of the eight HSSD patients had chronic active hepatitis with cirrhosis, and one had inactive cir rhosis. All three patients with HSSC and the one with HIS had chronic persistent hepatitis, with periportal fibrosis in three. All specimens from the 50 HBsAg-negative HSSC patients showed periportal fibrosis. These findings suggest that concomitant HBV infection is a major facto r determining severity of hepatosplenic schistosomiasis. (C) 1994 Wile y-Liss, Inc.