title: Initial load of hepatitis B virus (HBV), its changing profile, and precore/core promoter mutations correlate with the severity and outcome of acute HBV infection.
abstract: BACKGROUND
  The pathogenesis of the fulminant or severe form of acute hepatitis B virus (HBV) infection remains unclear, although both host- and virus-specific factors are considered to have a great impact on the c course. We aimed to define possible viral factors implicated in the severe form of acute HBV infection.
  
  
  METHODS
  We investigated viral factors in 42 patients with acute HBV infection: 11 had fulminant hepatitis (FH); 9 had a severe form of acute hepatitis (SAH), defined as having a prothrombin activity of less than 40% without encephalopathy; and 22 had acute self-limited hepatitis (AH).
  
  
  RESULTS
  Although there was no significant difference in serum HBV DNA levels on admission among the three groups, the level decreased more rapidly in patients with SAH or FH than in those with AH. In patients with SAH or FH, the HBV load on admission was higher in patients who died than in those who recovered (7.0 +/- 1.6 vs 5.6 +/- 1.0 log copies/ml; P=0.0293). In univariate analysis, seronegativity for hepatitis B envelope antigen (HBeAg) and mutations in both the precore (G1896A and/or G1899A) and core promoter (T1753A/C and/or T1754C/G and/or A1762T/G1764A) were associated with FH (odds ratio [OR], 5.60; P=0.0269 and OR, 52.0; P=0.0006; respectively). In multivariate logistic regression analysis, only the presence of precore/core promoter mutations was associated with FH (OR, 42.8; P=0.0020).
  
  
  CONCLUSIONS
  The rapid decrease in viral load in the early phase of acute HBV infection was associated with the severity of the disease. A high viral load on admission and the presence of both precore and core promoter mutations in patients with severe coagulopathy closely correlated with mortality.
authors: First Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
authors: Shigehiko
authors: S
authors: Sainokami
authors: Koichi
authors: K
authors: Abe
authors: Akihiro
authors: A
authors: Sato
authors: Ryujin
authors: R
authors: Endo
authors: Yasuhiro
authors: Y
authors: Takikawa
authors: Kazuyuki
authors: K
authors: Suzuki
authors: Hiroaki
authors: H
authors: Okamoto
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D005838:Genotype; D006509:Hepatitis B / Q000097:blood* / Q000401:mortality*; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011401:Promoter Regions, Genetic / Q000235:genetics; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D004279:DNA, Viral