PRECORE MUTANT OF HEPATITIS-B VIRUS IN CHILDHOOD FULMINANT-HEPATITIS-B - AN INFREQUENT ASSOCIATION

Serum HBV DNA from infants and children with fulminant hepatitis B (FH B) or acute self-limiting hepatitis B (AHB) and patients believed to b e contamination sources was amplified by polymerase chain reaction (PC R) followed by direct sequencing of the precore region. A precore muta tion from G to A at nucleotide 1896 was found in 5 of 14 FHB patients and in 3 of 10 AHB patients. Among the 10 infants who developed hepati tis during the first 6 months of age, the precore mutation was detecte d in only 2 of 7 with FHB and in 1 of 3 with AHB. In 1 infant with FHB , a shift from wild type to precore mutant predominance occurred in th e serum virus population during the incubation period. Thus, the preco re mutation is neither necessary nor sufficient to cause FHB in childh ood, although its contributory role cannot be excluded. Factors other than precore mutations may be important in the pathogenesis of FHB.