ObjectivesIt has been controversial whether or not the emergence of precore mutant HBV is related to the severe form of chronic hepatitis B (CH-B). To further clarify the role of the precore mutant HBV in the natural course of CH-B, we conducted a longitudinal analysis of precore-region sequences according to the biochemical severity along with seroconversion to anti-HBe in patients with CH-B.MethodsThe precore sequences of the ten sets of serial serum samples, obtained from 6 chronic hepatitis B patients with (group I) and from 4 patients without subsequent biochemical remission after seroconversion to anti-HBe (group II), were analyzed by direct sequencing of DNA amplified by PCR.ResultsThe precore mutat HBV having a G-A mutation at the nucleotide 1896 was most commonly found (9/10). Wild-type precore HBV was detected in 4 of 6 (66.7%) in group I and 3 of 4 (75.0%) in group II during HBeAg-positive period (p >0.05), and during anti-HBe-positive period it was found in 2 of 6 (33.3%) in group I and 0 of 4 (0%) in group II (p >0.05). In contrast, precore mutant HBV was detected in 5 of 6 (83.3%) in group I and 2 of 4 (50.0%) in group II during HBeAg-positive period (p >0.05), and in all patients of both groups during anti-HBe-positive period.ConclusionThe most common type of precore mutant HBV in Korea was the mutant with a G-A mutation at nucleotide 1896. The emergence of precore mutant HBV was a universal phenomenon during the natural history of CH-B; therefore, the precore mutant does not appear to have an pathogenic role in determining the severity of the CH-B.
Objectives:The present study was conducted to evaluate the prognostic significance of the absence of serum HBV DNA by polymerase chain reaction (PCR) after spontaneous HBeAg/anti-HBe seroconversion and concurrent or subsequent biochemical remission.Methods:We prospectively investigated the reactivation rates in 28 chronic hepatitis B patients according to the positive or negative serum HBV DNA test by PCR. The sera drawn at a mean period of 4.4months after normalization of alanine aminotransferase (ALT) were analyzed by PCR-Southern blot hybridization to detect HBV DNA, and then the patients were divided into two groups according to the presence (n=14) or absence (n=14) of HBV DNA in the sera.Results:The cumulative reactivation rates in patients with HBV DNA in sera were 43%, 57%, 57%, 57% and 57% at the end of 1st, 2nd, 3rd, 4th and 5th year after normalization of ALT, respectively, and those in patients without demonstrable HBV DNA were 50%, 66%, 74%, 74% and 83%, respectively; thus, the difference in the cumulative reactivation rates between patients with and without serum HBV DNA was not statistically significant (p=0.79), and irrespective of the status of HBV DNA in sera by PCR, reactivations occurred very rarely after 2 years of a sustained remission.Conclusions:We conclude that the seroconversion to anti-HBe accompanied by disappearance of serum HBV DNA even by PCR does not necessarily suggest a sustained remission of chronic hepatitis B.
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