High incidence of hepatitis B infections among chronic hepatitis cases of unknown aetiology

J Hepatol. 2001 Mar;34(3):447-54. doi: 10.1016/s0168-8278(00)00100-8.


Background/aims: In approximately 5% of chronic liver disease cases, no aetiology can be identified. We selected sera from 50 patients with chronic hepatitis of unknown aetiology who were enrolled in this follow-up study whose aim is to gain insight into the possible role of viruses and to define potential clinical outcomes.

Methods: Patients' sera were screened with highly sensitive polymerase chain reaction assays for hepatitis B (HBV), C, D, and G viruses and TT virus. Sera were also retested for antibodies against the core antigen of HBV.

Results: Surprisingly, HBV DNA was detected in both serum and liver in 15/50 (30%) patients. Immunostaining for HBV antigens on biopsies from patients positive for HBV DNA showed HBcAg and/or HBsAg expression at low levels in 9/15 samples. Eleven of the fifteen patients were anti-HBc positive. With one exception, all patients carried HBV genomes at low levels (10(4) copies/ml or less). Histological signs of chronic liver disease were observed in all patients.

Conclusion: Unrecognised HBV infections may account for a high proportion of chronic hepatitis cases of unknown aetiology. Improved HBV detection tests, which appear mandatory for the diagnosis and management of non-A non-E hepatitis as well as for improved safety of transfusions and transplantations are needed.

MeSH terms

  • Adult
  • Antigens, Viral / analysis
  • Base Sequence / genetics
  • DNA, Viral / blood
  • DNA, Viral / genetics
  • DNA, Viral / metabolism
  • Female
  • Genome, Viral
  • Hepatitis B / epidemiology*
  • Hepatitis B virus / genetics
  • Hepatitis B virus / immunology
  • Hepatitis, Chronic* / immunology
  • Hepatitis, Chronic* / metabolism
  • Hepatitis, Chronic* / pathology
  • Humans
  • Incidence
  • Liver / immunology
  • Liver / metabolism
  • Liver / pathology
  • Male
  • Middle Aged
  • Molecular Sequence Data
  • Viral Load


  • Antigens, Viral
  • DNA, Viral