Reactivation of chronic type B hepatitis: the effect on expression of serum HBV-DNA and pre-S encoded proteins

Levels of pre-S antigens and HBV DNA in sera from high and low viremic HBV carriers

The biological and clinical significances of pre-S antigens and HBV replication were investigated. Some 125 sera, 28 from HBeAg and 97 from anti-HBe-positive HBsAg, carriers were studied. The aim was to verify whether pre-S antigens could be expressed in serum in complete absence of viremia. Pre-S proteins, determined by an enzyme immunoassay, were found in sera regardless of the presence of HBV DNA, as detected by spot-hybridization. The sera without detectable HBV DNA were investigated further by PCR using specific primers for the S and C regions of HBV. PCR analysis of samples revealed that 4 out of 5 HBeAg and 33 out of 41 (80.5%) anti-HBe positive sera contained HBV-amplified sequences of S and C regions. Pre-S antigen values correlated well with the amounts of HBV DNA in serum detected by PCR in anti-HBe-positive subjects with high titers of pre-S antigens (10(4)-10(6)). In addition, PCR highlighted the presence of HBV DNA sequences in 8 out of 17 (47.1%) pre-S-negative HBsAg-positive sera.

Clinical course of spontaneous reactivation of hepatitis B virus infection in patients with chronic hepatitis B

The purposes of this study were (a) to describe the clinical and biochemical manifestations associated with spontaneous reactivation of hepatitis B virus as defined by the reappearance of hepatitis B virus DNA in serum using dot-blot hybridization and (b) to determine whether the clinical and biochemical manifestations associated with hepatitis B virus reactivation were different in patients with and without human immunodeficiency virus-1 infection. During 1 yr, 110 French patients were admitted to Hôpital Beaujon for chronic hepatitis B. Fourteen were found to have hepatitis B virus reactivation; of these, three were anti-human immunodeficiency virus-1-positive. These 14 patients were HBsAg-positive for 60 mo (range = 6 to 180 mo). Clinical manifestations related to reappearance of hepatitis B virus DNA were present in 11 patients. HBeAg/anti-HBe status did not change in nine patients in whom hepatitis B virus reactivation would not have been recognized without hepatitis B virus DNA testing. Cirrhosis was present in nine patients. Four patients, of whom two were anti-human immunodeficiency virus-1-positive, had fulminant liver failure. Two patients died; one was anti-human immunodeficiency virus-1-positive. One patient was given an emergency transplant.

Immune blot analysis of viral surface proteins in serum and liver of patients with chronic hepatitis B virus infection

The small and the middle surface proteins of hepatitis virus form either the virion or the 22 nm particle both of which are secreted. The large surface protein by itself remains cell bound in artificially transfected cell culture unless it is accompanied by an excess of the smaller protens. Its behavior in vivo is not yet well studied. Using specific monoclonal antibodies for immunoblotting, we found an abundance of small surface protein in the serum of chronic virus carriers and moderate amounts in the liver irrespective of viremia. The large surface protein was present in the serum and the liver of viremic carriers. In nonviremic carriers, the large protein was absent from serum, but in the liver a shorter form of the large protein was readily detectable. These findings suggest a complex regulatory mechanism of the viral surface protein depending on the expression of other viral gene products.