title: Detection of HBV core promoter and precore mutations helps distinguish flares of chronic hepatitis from acute hepatitis B.
abstract: OBJECTIVE
  Acute exacerbation of chronic hepatitis B has to be distinguished from acute hepatitis, because treatment strategies differ between them.
  
  
  METHODS
  Mutations in the core promoter and precore region of hepatitis B virus (HBV) were determined in 36 patients with acute exacerbation of chronic hepatitis B, in whom alanine aminotransferase (ALT) increased above 500 IU/L, as well as the 36 patients with acute hepatitis.
  
  
  RESULTS
  Mutations in the core promoter (A1762T/G1764A) and precore region (G1896A) were more frequent in patients with acute exacerbation of chronic hepatitis than acute hepatitis (81% vs 19%; P < 0.0001 and 58% vs 6%; P < 0.0001, respectively). Of the 19 patients with mutations in both the core promoter and precore region, 17 (89%) had acute exacerbation of chronic hepatitis. In contrast, among the 32 patients with the wild-type for both the core promoter and precore region, 29 (89%) developed acute hepatitis. By multivariate analysis, the double mutation in the core promoter was predictive of acute exacerbation in chronic hepatitis with the highest odds ratio at 26.4.
  
  
  CONCLUSIONS
  In patients with hepatitis B having ALT levels >500 IU/L, mutations in the core promoter and precore region are useful in distinguishing acute exacerbation of chronic from acute HBV infection. Detection of these mutations would be useful for commencing prompt antiviral treatments on patients with acute exacerbation of chronic hepatitis for a better prognosis.
authors.affiliation: First Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kusumoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuhashi
authors.forename: Rumiko
authors.initials: R
authors.lastname: Nakao
authors.forename: Rumiko
authors.initials: R
authors.lastname: Hamada
authors.forename: Mika
authors.initials: M
authors.lastname: Fukuda
authors.forename: Yoko
authors.initials: Y
authors.lastname: Tamada
authors.forename: Naota
authors.initials: N
authors.lastname: Taura
authors.forename: Atsumasa
authors.initials: A
authors.lastname: Komori
authors.forename: Manabu
authors.initials: M
authors.lastname: Daikoku
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hamasaki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ishibashi
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Miyakawa
authors.forename: Katsumi
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000821:virology*; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011401:Promoter Regions, Genetic / Q000235:genetics*