Clinical and virological characteristics associated with severe acute hepatitis B

To identify early predictors of a severe or fulminant course in patients with acute viral hepatitis B (AVH-B).138 patients with symptomatic acute hepatitis B observed from 1999 to 2012 were enrolled. For each patient, the demographics, risk factors for the acquisition of HBV infection, clinical, biochemical and virological data (HBV DNA, HBV DNA sequences) were recorded and analyzed. The HBV mutants in the polymerase region were sought in 110 (87\%) patients by direct sequencing, and the rtM204V/I mutations also by an allele-specific polymerase chain reaction.AVH-B was severe in 13 (9.4\%) of the 138 patients enrolled, fulminant in 6 (4.3\%) and with a normal clinical course in 119. The 19 patients with severe or fulminant AVH-B more frequently than the 119 with a normal course stated intravenous drug use (63.2\% vs. 36.1\%, p=0.04) and were HBV-DNA negative (31.6\% vs. 11.8\%, p = 0.03) and anti-HCV positive (57.9\% vs. 19.3\%, p=0.0008); the prevalences of different HBV genotypes and of the rtM204V/I mutant were similar in these three forms of AVH-B. A multivariate logistic regression analysis identified a pre-existing HCV chronic infection as the only factor independently associated with a severe or fulminant clinical course of AHV-B (O.R.: 4.89, C.I. 95\%: 1.5-15.94, p=0.01).A pre-existing HCV chronic infection was identified as the only factor independently associated with a severe clinical presentation of acute hepatitis B, an association most probably due to the combination of the liver lesions caused by acute hepatitis B and the pre-existing histological abnormalities related to HCV chronic infection This article is protected by copyright. All rights reserved.