Changes in hepatitis B virus DNA polymerase in relation to the outcome of acute hepatitis type B.

Abstract

SUMMARY Serum levels of hepatitis B virus specific DNA polymerase and hepatitis B e antigen were studied serially in 34 patients with hepatitis B virus infection-20 who had the acute illness and recovered, seven who died with fulminant disease, three who died as a result of subacute hepatic necrosis, and four who went on to develop chronic active hepatitis. DNA polymerase activity was present in 16 (80 %) and HBeAg in 13 (65 %) of the uncomplicated cases at presentation and in all of those patients from whom the initial sample was obtained before the peak in aminotransferase. Both markers disappeared after 30 days from the onset but DNAP remained persistently positive during a follow-up period of four to 10 months in the four patients who progressed to chronic hepatitis. These results indicate that DNAP and HBeAg are transiently present in all cases of acute hepatitis B. Only their persistence after the acute episode could represent a useful prognostic marker of chronicity. In this respect, DNAP was more reliable in our patients than HBeAg. In uncomplicated acute hepatitis, the peak in DNAP levels, which defines the time of maximum virus replication in the liver, preceded the peak in aminotransferase levels. Among the 10 patients who developed massive liver damage after hepatitis B infection, DNAP was detected in five of the seven with fulminant hepatitis, with enzyme levels that were comparable with those observed in uncomplicated acute hepatitis at presentation, but not in the cases of subacute hepatic necrosis. These findings are consistent with the hypothesis that in hepatitis B infection, liver damage, whatever the severity, is not directly related to the degree of virus replication.

Serum Hepatitis B Virus DNA in Acute Hepatitis Type B

“…In contrast, a per sistent positivity for serum HBV-DNA has been demonstrated in all acute hepatitis cases showing chronic evolution. This is in agree ment with demonstration of large numbers of circulating complete virions and of persis tence of serum HBV-DNA polymerase activ ity in similar patients [1,8]. This different behaviour compared to that in uncompli cated cases does not appear merely as a con sequence of variations in time of sampling or in disease expression.…”

Hepatitis B virus DNA in children's liver diseases: detection by blot hybridisation in liver and serum.

“…In general, the severity of liver damage in fulminant cases of hepatitis does not seem to be directly related to the degree of viral multiplication. 16 One explanation suggested for massive hepatocellular necrosis is the destruction of a large number of infected hepatocytes by immune mechanisms. In the connection, the occurrence of an early enhanced humoral antibody response was stressed in contrast with the late outcome of the same humoral pattern during recovery in selflimited acute hepatitis.17-19 Cell-mediated immunity is also a probable factor determining the clinical course of HBV infection.20…”

Radioimmunoassay for Hepatitis B‘e’Antigen and Antibody: Correlations with Viral Replication and Prognostic Value

“…Some authors concluded that HBeAg in acute hepatitis indicated progression to chronicity [1,2], while others reported that HBeAg does not have this prognostic significance [3,4]. Fur thermore the nature of HBeAg and its rela tion to the infectivity of the sera evaluated by [6][7][8] but the data obtained showed different incidences of positive correlations.…”

“…In a group of 31 randomly selected sera the presence of Dane particles-associated DNAP activity was deter mined in 20-fold concentrated pellets prepared from sera by ultracentrifugation according to the method of Kaplan et al [13] as modified by Alberti et al [8], The specificity of the enzymatic activity was determined by precipitation with an anti-HBs antiserum.…”