title: Clinical and virological characteristics associated with severe acute hepatitis B.
abstract: To identify early predictors of a severe or fulminant course in patients with acute viral hepatitis B (AVH-B). One hundred and thirty-eight patients with symptomatic acute hepatitis B observed from 1999 to 2012 were enrolled. For each patient, the demographics, risk factors for the acquisition of hepatitis B virus (HBV) infection, clinical, biochemical and virological data (HBV DNA, HBV DNA sequences) were recorded and analysed. The HBV mutants in the polymerase region were sought in 110 (87%) patients by direct sequencing, and the rtM204V/I mutations also by an allele-specific PCR. AVH-B was severe in 13 (9.4%) of the 138 patients enrolled, fulminant in 6 (4.3%) and with a normal clinical course in 119. The 19 patients with severe or fulminant AVH-B more frequently than the 119 with a normal course stated intravenous drug use (63.2% versus 36.1%, p 0.04) and were HBV-DNA negative (31.6% versus 11.8%, p 0.03) and anti-hepatitis C virus (HCV) positive (57.9% versus 19.3%, p 0.0008); the prevalences of different HBV genotypes and of the rtM204V/I mutant were similar in these three forms of AVH-B. A multivariate logistic regression analysis identified a pre-existing HCV chronic infection as the only factor independently associated with a severe or fulminant clinical course of AVH-B (OR 4.89, 95% CI 1.5-15.94, p 0.01). A pre-existing HCV chronic infection was identified as the only factor independently associated with a severe clinical presentation of acute hepatitis B, an association most probably due to the combination of the liver lesions caused by acute hepatitis B and the pre-existing histological abnormalities related to HCV chronic infection.
authors.affiliation: Department of Mental Health and Public Medicine, Section of Infectious Diseases, Naples, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Coppola
authors.forename: C
authors.initials: C
authors.lastname: Sagnelli
authors.forename: M
authors.initials: M
authors.lastname: Pisaturo
authors.forename: C
authors.initials: C
authors.lastname: Minichini
authors.forename: V
authors.initials: V
authors.lastname: Messina
authors.forename: L
authors.initials: L
authors.lastname: Alessio
authors.forename: M
authors.initials: M
authors.lastname: Starace
authors.forename: G
authors.initials: G
authors.lastname: Signoriello
authors.forename: I
authors.initials: I
authors.lastname: Gentile
authors.forename: P
authors.initials: P
authors.lastname: Filippini
authors.forename: E
authors.initials: E
authors.lastname: Sagnelli
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000737:chemistry / Q000235:genetics; D003710:Demography; D005260:Female; D005838:Genotype; D006509:Hepatitis B / Q000473:pathology* / Q000821:virology*; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008297:Male; D009154:Mutation; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D017422:Sequence Analysis, DNA
chemical_list: D004279:DNA, Viral
keywords: Acute hepatitis B; fulminant hepatitis; hepatitis C virus chronic infection; severe acute hepatitis