FREQUENCY AND CLINICAL PROFILE OF PRECORE AND SURFACE HEPATITIS-B MUTANTS IN ASIAN-INDIAN PATIENTS WITH CHRONIC LIVER-DISEASE

Background: Infection due to hepatitis B virus (HBV) could be due to w ild or mutant (precore or surface) viruses. The prevalence and clinica l profile of different viral forms in patients with chronic liver dise ase has not been established. Methods: One hundred and twenty patients with histologically proven HBV-related chronic liver disease were stu died. Patients with dual infection with HCV/HDV/HIV, past history of i nterferon therapy, or autoimmune hepatitis were excluded. Eighteen (15 .5%) patients had the precore mutation (HBsAg +ve, HBeAg -ve/anti-HBe +ve, HBVDNA +ve), and 13 (10.8%) had the surface gene mutations (HBsAg -ve, HBeAg -ve, IgG anti-HBc, and HBV DNA +ve). The remaining 89 (74. 2%) patients were infected with wild type HBV. The course of all patie nts with mutant forms and tl of those with the wild type form was foll owed for a mean (+/- SD) of 4.4 +/- 2.4 yr. Results: Compared with wil d-type-infected patients, those with surface mutation were younger (39 .9 +/- 14 vs. 30.1 +/- 12.4 yr, p < 0.05). Patients with precore mutat ions had a shorter illness than those with surface mutant (p < 0.01) a nd wild forms (p < 0.05). Histologically, patients with precore type h ad more active li, er disease than wild type (39% vs. 15%, p < 0.05). Patients with precore mutations were always symptomatic, often present ing with ascites (67%) and jaundice (55%). Patients with surface mutan t forms often presented with quiescent cirrhosis (77%) or cirrhosis wi th hepatoma (15%). Conclusions: One-fourth of HBV-related chronic Live r disease in Asian Indians is attributable to mutant HBV forms. The pr esence of variant viruses alters the natural history of the disease, w ith the precore variance having a more aggressive course and the surfa ce mutant, a more quiescent but unfavorable course, compared with the wild type.