High Levels of HBV after the Onset Lead to Chronic Infection in Patients with Acute Hepatitis B
Hiroshi Yotsuyanagi1,7,
Kiyoaki Ito2,5,7,
Norie Yamada1,3,4,
Hideaki Takahashi3,
Chiaki Okuse3,
Kiyomi Yasuda4,
Michihiro Suzuki3,
Kyoji Moriya1,
Masashi Mizokami2,
Yuzo Miyakawa6, and
Kazuhiko Koike1
+ Author Affiliations
1Department of Internal Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo, Tokyo, Japan
2The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan
3Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
4Department of Internal Medicine, Center for Liver Diseases, Kiyokawa Hospital, Suginami, Tokyo, Japan
5Department of Microbiology and Immunology, Aichi Medical University School of Medicine and
6Miyakawa Memorial Research Foundation, Minato, Tokyo, Japan
Corresponding Address requests for reprints to: Hiroshi Yotsuyanagi, MD, Graduate Institute of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo 113-8655, Japan. e-mail: hyotsu-***@****; phone: 81-3-5800-8801, fax: 81-3-5800-8804.
↵7 H.Y. and K.I equally contributed to this work
Abstract
Background. Some patients with acute HBV infection develop chronic infection. However, the method for identifying them has not been established.
Methods. We followed 215 Japanese patients with acute HBV infection until the clearance of HBsAg or the development of chronic infection. Levels of HBsAg and HBV DNA were serially monitored from the onset.
Results. Of the 215 patients, 113 (52.5%) possessed HBV genotype A, 26 (12.0%) genotype B, and 73 (34.0%) genotype C. Twenty-one of the 215 (9.8%) developed chronic infection, with the persistence of HBsAg for>6 months. The rate of chronicity of genotype A, B, and C was 12.4%, 3.8%, and 8.2%. Of the 21 patients, only six (2.8%) patients, including five with genotype A, failed to clear HBsAg within 12 months. Levels of HBsAg at 12 weeks and HBV DNA at 4 weeks were useful for distinguishing the patients who became chronic from those who did not (P <.001 and P<.001, respectively). Likewise, the levels of HBsAg at 12 weeks and HBV DNA at 8 weeks were useful for discriminating between the patients who lost HBsAg within 12 months and those who did not (P<.01 and P<.05, respectively).
Conclusions. In acute HBV infection, clearance of HBV may happen between 6 and 12 months from the onset. Only those who fail to clear HBV within 12 months from the onset may really develop chronic infection.
Received February 14, 2013.
Accepted May 9, 2013.
© The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.***@****.