Reactivation of precore variant hepatitis B virus in a child with severe aplastic anaemia

Reactivation of hepatitis B e antigen (HBeAg) negative chronic hepatitis B virus (HBV), infection due to selection of precore variant virus is an unco mmon complication of previous hepatitis B infection, and virtually unrecogn ised in children and adolescents. A child who had received: treatment with methylprednisolone and antilymphocyte globulin for severe aplastic anaemia developed high levels of detectable HBV DNA associated with hepatitis B e a ntibody (anti-HBe) positivity. HBV DNA was extracted, amplified and the cor e and precore regions sequenced from 2 samples. A mixture of wild-type and the precore variants A(1896) and A(1899) was detected in both samples, with the wild-type predominating: in the second sample. Reinfection was exclude d by phylogenetic analysis using Phylip and the neighbour-joining method. P recore variant Hepatitis B virus can be transmitted, to children as a prima ry infection, and it is important that aggressive liver disease, particular ly in the presence of the anti-HBe phenotype, be investigated. Further stud ies are needed to determine the frequency of these variants. (C) 2001 Wiley -Liss, Inc.