Some epidemiological and clinical aspects of hepatitis B antigen and its subtypes.

The close association between hepatitis B antigen (HBAg) and the infectious agent of hepatitis B is clear. Many investigations have shown HBAg to be a useful tool for epidemiological studies of hepatitis B. The relation between HBAg and the postulated hepatitis B virus (HBV) is as yet not clear. In light of recent results a possible candidate could be the so-called Dane particle, which has HBAg reactivity on the surface, but possesses an antigenically distinct core. The core has been shown to have associated DNA polymerase activity. The particles which carry HBAg reactivity have surfaces which are antigenically complex. One common specificity a and 2 pairs of mutually exclusive determinants have been recognized namely d and y and w and r but further possible specificities are under investigation. Four different phenotypes have been described, adw, adr, ayw and ayr. Present evidence indicates that adw, adr and ayw are the phenotypic expression of 3 different transmissible strains of HBV. Studies on the epidemiology of these subtypes have shown 3 different geographic patterns. In the USA and Northern Europe both Dw (adw) and YW (ayw) are common, but in the Eastern Mediterranean and Middle East Yw is practically the only type found. In the Far East DR (adr) is the dominating subtype. Investigations have been done to determine whether there are any clinical differences in hepatitis caused by the different tubtypes. No certain differences have been shown.