Chronic liver disease developing after infection with the hepatitis B virus may be due to impairment of cell-mediated immunity (CMI). In a study of CMI by the lymphocyte transformation test to two mitogens and hepatitis B surface antigen (HBsAg) the response to the mitogens, phytohemagglutinin (PHA) and purified protein derivative (PPD), was normal in all of 15 male homosexuals with HBsAg-positive chronic liver disease, indicating a normal non-specific cellular immune response. By contrast, only one of the 15 patients showed a response to HBsAg, which may explain the high prevalence of chronic HBsAg carriage in these patients.
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