title: High levels of hepatitis B virus after the onset of disease lead to chronic infection in patients with acute hepatitis B.
abstract: BACKGROUND
  Some patients with acute hepatitis B virus (HBV) infection develop chronic infection. However, the method for identifying these patients has not been established.
  
  
  METHODS
  We followed 215 Japanese patients with acute HBV infection until the clearance of hepatitis B surface antigen (HBsAg) or the development of chronic infection. Levels of HBsAg and HBV DNA were serially monitored from the onset.
  
  
  RESULTS
  Of the 215 patients, 113 (52.5%) possessed HBV genotype A, 26 (12.0%) genotype B, and 73 (34.0%) genotype C. Twenty-one of the 215 (9.8%) developed chronic infection, with the persistence of HBsAg for >6 months. The rate of chronicity of genotype A, B, and C was 12.4%, 3.8%, and 8.2%. Of the 21 patients, only 6 (2.8%) patients, including 5 with genotype A, failed to clear HBsAg within 12 months. Levels of HBsAg at 12 weeks and HBV DNA at 4 weeks were useful for distinguishing the patients who became chronic from those who did not (P < .001 and P < .001, respectively). Likewise, the levels of HBsAg at 12 weeks and HBV DNA at 8 weeks were useful for discriminating between the patients who lost HBsAg within 12 months and those who did not (P < .01 and P < .05, respectively).
  
  
  CONCLUSIONS
  In acute HBV infection, clearance of HBV may happen between 6 and 12 months from the onset. Only those who fail to clear HBV within 12 months from the onset may develop chronic infection.
authors.affiliation: Department of Internal Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yotsuyanagi
authors.forename: Kiyoaki
authors.initials: K
authors.lastname: Ito
authors.forename: Norie
authors.initials: N
authors.lastname: Yamada
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Chiaki
authors.initials: C
authors.lastname: Okuse
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Yasuda
authors.forename: Michihiro
authors.initials: M
authors.lastname: Suzuki
authors.forename: Kyoji
authors.initials: K
authors.lastname: Moriya
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Miyakawa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000208:Acute Disease; D000328:Adult; D016009:Chi-Square Distribution; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D005838:Genotype; D006509:Hepatitis B / Q000097:blood / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000821:virology*; D006801:Humans; D008297:Male; D010802:Phylogeny; D015995:Prevalence; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens
keywords: genotype; hepatitis B virus; hepatitis B virus antigen