LOW-LEVEL HEPATITIS-B VIREMIA DETECTED BY POLYMERASE CHAIN-REACTION ACCOMPANIES THE ABSENCE OF HBE ANTIGENEMIA AND HEPATITIS IN HEPATITIS-BVIRUS CARRIERS

Objectives: Because outcome of antiviral treatment in patients with ch ronic hepatitis (CH) B is difficult to predict, we compared the severi ty of hepatitis with serum hepatitis B virus (HBV) DNA concentration. Methods: We studied 40 HBV carriers with distinct stages of chronic in fection, 32 HBe antigen (HBeAg) -negative or low-grade positive carrie rs whose HBV strains did not contain a point mutation at nucleotide 18 96, 37 HBeAg-negative carriers with or without hepatitis, and 51 HBeAg -positive CH patients treated with interferon. Serum HBV DNA concentra tion was measured by the end-point dilution method using a polymerase chain reaction (PCR). The point mutation at nucleotide 1896 was detect ed by restriction fragment length polymorphism with PCR. Results: Amon g the stages of chronic HBV infection, the serum HBV DNA concentration was lowest (10(0.67 +/- 0.71) copies/mu l) in HBeAg-negative asymptom atic carriers. A low-level viremia (10(2.10 +/- 1.45) copies/mu l) of HBV strains without the mutation at nucleotide 1896 was associated wit h an HBeAg-negative state. In HBeAg-negative carriers, the serum HBV D NA concentration in those without hepatitis was significantly lower th an in those with hepatitis (10(1.00 +/- 0.89), 10(3.31 +/- 1.25) copie s/mu l, p < 0.0001); 20 of 21 asymptomatic carriers had an HBV DNA con centration below 10(2) copies/mu l. Patients with serum HBV DNA concen trations below 10(1) copies/mu l at the end of interferon treatment ma intained normal serum alanine aminotransferase concentrations. Conclus ions: A serum HBV DNA concentration below 10(1) copies/mu l is an impo rtant goal for successful treatment of CH-B. PCR is necessary to asses s such low-level viremias.