title: Reactivation of precore variant hepatitis B virus in a child with severe aplastic anaemia.
abstract: Reactivation of hepatitis B e antigen (HBeAg) negative chronic hepatitis B virus (HBV) infection due to selection of precore variant virus is an uncommon complication of previous hepatitis B infection, and virtually unrecognised in children and adolescents. A child who had received treatment with methylprednisolone and antilymphocyte globulin for severe aplastic anaemia developed high levels of detectable HBV DNA associated with hepatitis B e antibody (anti-HBe) positivity. HBV DNA was extracted, amplified and the core and precore regions sequenced from 2 samples. A mixture of wild-type and the precore variants A(1896) and A(1899) was detected in both samples, with the wild-type predominating in the second sample. Reinfection was excluded by phylogenetic analysis using Phylip and the neighbour-joining method. Precore variant Hepatitis B virus can be transmitted to children as a primary infection, and it is important that aggressive liver disease, particularly in the presence of the anti-HBe phenotype, be investigated. Further studies are needed to determine the frequency of these variants.
authors.affiliation: Department of Virology, Barts and the London NHS Trust, London, England.
authors.forename: P R
authors.initials: PR
authors.lastname: Smith
authors.forename: R
authors.initials: R
authors.lastname: Zampino
authors.forename: C
authors.initials: C
authors.lastname: Gutteridge
authors.forename: P
authors.initials: P
authors.lastname: Karayiannis
authors.forename: C
authors.initials: C
authors.lastname: Aitken
mesh_terms: D000741:Anemia, Aplastic / Q000150:complications*; D002648:Child; D004279:DNA, Viral / Q000097:blood; D014644:Genetic Variation; D006509:Hepatitis B / Q000150:complications / Q000821:virology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood / Q000235:genetics / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics / Q000254:growth & development*; D006801:Humans; D008297:Male; D009154:Mutation; D014775:Virus Activation
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006513:Hepatitis B e Antigens