Persistence of hepatitis B viremia after recovery from acute hepatitis B: correlation between anti-HBc titer and HBV DNA in serum

During the follow-up of 19 patients with self-limited acute hepatitis B for more than 2 years, clearance of hepatitis B surface antigen from the sera was observed in all patients within 6 months after disease onset, and the corresponding antibody (anti-HBs) appeared in 17 of the 19 patients within 12 months. However, upon performing nested polymerase chain reaction with the estimated sensitivity of 120-200 copies/ml, using two independent pairs of primers derived from the well-conserved sequences in the S gene or C gene region of the hepatitis B virus (HBV) genomes of all seven genotypes, HBV DNA was detected over a period of at least 12 months in serum samples obtained from five (26%) of the 19 patients, although it became undetectable in all five patients at 2-3 years after disease onset. The titer of antibody against hepatitis B core antigen (anti-HBc), assayed by the hemagglutination inhibition (HI, 2) test, was significantly lower at the initial examination in the five patients who remained viremic for at least 12 months, than in the remaining 14 patients who cleared HBV DNA from their sera within 12 months after disease onset (10.6 +/- 2.7 vs. 13.6 +/- 0.7, P < 0.02). Furthermore, these five patients showed a significantly lower rate of decrease of anti-HBc titer during the 12-month period after disease onset than the remaining 14 patients (55.0 +/- 32.6 vs. 91.0 +/- 7.9%, P < 0.01). These results indicate that the initial titer and dynamics of anti-HBc may reflect the evolution of HBV viremia after clinical recovery from acute hepatitis B. (C) 2002 Elsevier Science B.V. All rights reserved.