Detection of HBV core promoter and precore mutations helps distinguish flares of chronic hepatitis from acute hepatitis B.
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.
Kusumoto
Koichiro
K
First Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
Yatsuhashi
Hiroshi
H
Nakao
Rumiko
R
Hamada
Rumiko
R
Fukuda
Mika
M
Tamada
Yoko
Y
Taura
Naota
N
Komori
Atsumasa
A
Daikoku
Manabu
M
Hamasaki
Keisuke
K
Nakao
Kazuhiko
K
Ishibashi
Hiromi
H
Miyakawa
Yuzo
Y
Eguchi
Katsumi
K
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*