Objectives: Because outcome of antiviral treatment in patients with chronic hepatitis (CH) B is difficult to predict, we compared the severity of hepatitis with serum hepatitis B virus (HBV) DNA concentration.
Methods: We studied 40 HBV carriers with distinct stages of chronic infection, 32 HBe antigen (HBeAg)-negative or low-grade positive carriers whose HBV strains did not contain a point mutation at nucleotide 1896, 37 HBeAg-negative carriers with or without hepatitis, and 51 HBeAg-positive CH patients treated with interferon. Serum HBV DNA concentration was measured by the end-point dilution method using a polymerase chain reaction (PCR). The point mutation at nucleotide 1896 was detected by restriction fragment length polymorphism with PCR.
Results: Among the stages of chronic HBV infection, the serum HBV DNA concentration was lowest (10(0.67 +/- 0.71) copies/microliter) in HBeAg-negative asymptomatic carriers. A low-level viremia (10(2.10 +/- 1.45) copies/microliter) of HBV strains without the mutation at nucleotide 1896 was associated with an HBeAg-negative state. In HBeAg-negative carriers, the serum HBV DNA concentration in those without hepatitis was significantly lower than in those with hepatitis (10(1.00 +/- 0.89) vs 10(3.31 +/- 1.25) copies/microliter, p < 0.0001); 20 of 21 asymptomatic carriers had an HBV DNA concentration below 10(2) copies/microliter. Patients with serum HBV DNA concentrations below 10(1) copies/microliter. at the end of interferon treatment maintained normal serum alanine aminotransferase concentrations.
Conclusions: A serum HBV DNA concentration below 10(1) copies/ microliter is an important goal for successful treatment of CH-B. PCR is necessary to assess such low-level viremias.