Infection Persists After Clinical Recovery in Acute Self-Limited Hepatitis B

Occult hepatitis B virus (HBV) often persists in the liver long after recovery becomes apparent in patients with acute self-limited infections, researchers reported. A medical team at Osaka National Hospital in Japan has explored long-term histologic and virologic outcomes in patients with acute self-limited HBV infections. According to the team's findings, many patients' livers still exhibit abnormalities and harbor viral infections ten years after clinical recovery.

The long-term investigation, headed by Nobukazu Yuki, included 14 patients with previous diagnoses of acute hepatitis B. The study, initiated a median of 4.2 years after the patients' disease was confirmed (range=1.8-9.5), continued for several more years, with at least nine of the 14 patients undergoing liver biopsies at a median of 7.2 years. When the study began, none of the patients had circulating HBV surface antigen (HBsAg), and all but two had formed antibodies to HBsAg. "Three patients had low levels of HBV DNA up to 8.9 years after the onset, whereas HBV DNA surface and X regions were found in the liver of all nine patients examined, including seven negative for serum HBV DNA," Yuki and colleagues reported.

The liver biopsies demonstrated a significant relationship between HBV DNA surface and X regions, the authors said. In addition, all patient's samples contained covalently closed circular HBV DNA. Liver fibroids and mild inflammation were detected by researchers in eight of the biopsied patients. "The fibrosis stage had relation to peak serum HBV DNA in the acute phase (p=0.046) but not to liver viral loads in the convalescent phase," said investigators. Yuki and colleagues concluded that occult HBV infection may persist in the liver longer than suspected in patients who recover from acute self-limited hepatitis B.

The full study, "Long-Term Histologic and Virologic Outcomes of Acute Self-Limited Hepatitis B," was published in the May issue of Hepatology (2003;37(5):1172-1179).

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