Correlation of HBeAg/anti-HBe, ALT levels, and HBV DNA PCR results in HBsAg-positive patients.
A highly sensitive polymerase chain reaction (PCR) was used to analyse serum samples from HBsAg-positive patients in Sweden. Forty-two chronic carriers were tested, five of whom were of Swedish origin. Of the total, there were 13 HBeAg-positive and 27 anti-HBe-positive patients, while 1 patient was negative for both HBeAg and anti-HBe and one was positive for both markers. Nine of the 13 HBeAg-positive carriers and only 7 of the 27 anti-HBe-positive carriers had elevated alanine transaminase (ALT) levels (P = 0.01). Two PCR tests of marginally different sensitivity were used on all patient samples. All 13 HBeAg-positive patients and the patients with and lacking both HBeAg and anti-HBe markers, respectively, were positive in both PCR tests. One HBeAg-positive patient was shown to shed hepatitis B virus (HBV) DNA in both saliva and urine. Twelve of the 27 anti-HBe-positive carriers, 6 of whom had elevated ALT levels, were PCR positive. The remaining 15 had no evidence of HBV DNA and all but 1 had normal ALT levels. A positive PCR result was more common in those anti-HBe-positive patients with elevated ALT levels (P < 0.02). The precore gene from 18 samples was sequenced and, with a few exceptions, showed a high degree of conservation. We suggest that in the absence of optimal tests for infectivity of serum from HBsAg-positive patients, and until PCR becomes more widely available, all anti-HBe-positive patients with elevated ALT levels be considered highly infectious.
Department of Infectious Diseases, University Hospital of Lund, Sweden.
K K
KK
Ljunggren
E
E
Nordenfelt
A
A
Kidd
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001483:Base Sequence; D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004277:DNA, Single-Stranded; D004279:DNA, Viral / Q000097:blood*; D006509:Hepatitis B / Q000097:blood* / Q000276:immunology / Q000382:microbiology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006513:Hepatitis B e Antigens / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D014766:Viremia / Q000276:immunology / Q000382:microbiology
D004277:DNA, Single-Stranded; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase