Agha Babar Hussain, Waheeduz Zaman Tariq, Masood Anwar, Amin Wiqar.
Anti-HBe positive Hepatitis B virus carriers with detectable HBV DNA.
Pak J Gastroenterol Jan ;20(1):1-5.

Most of the hepatitis B carriers in our set up are serologically negative for HBeAg and positive for anti-HBe, which depicts low grade of viral activity and infectivity whereas HBeAg positive and Anti HBe negative serostatus depicts high grade of viral activity and infectivity and is consistent with viraemic state. Mutation in pre-core region of HBV genome results in Anti-HBe positivity and loss of HBeAg inspite of HBV viremia. Infection with Hepatitis B virus pre-core mutants renders serological identification based upon HBeAg and Anti HBe testing unreliable, necessitating the detection of viral DNA in these patients. This study determines the prevalence of pre-core mutants and its effect in term of serum ALT levels in HBV carriers. It was a descriptive, prospective study done at Virology department AFIP Rawalpindi, from July 2002 to June 2003. The sera of 100 hepatitis B carriers with Anti HBe positive sero-status were tested for HBV-DNA by Polymerase Chain Reaction (PCR) and serum Alanin Transaminase (ALT) levels. Detection of veraemia was consistent with possible pre-core mutation. HBV DNA was found in 19% (19/100) of HBeAg-negative and Anti-HBe-positive carriers suggesting a prevalence rate of 19% for pre-core mutants. The raised serum ALT level was found in 42.1% (8/19) carriers with detectable HBV DNA whereas only 11% (9/81) of those without veraemia had raised ALT level. HBV pre-core mutants are common and can therefore present a problem during diagnosis, grading, monitoring and treatment of the HBV carriers. 42.1% (8/19) of pre-core mutants show evidence of liver damage as compared with 11% cases infected with wild virus, thus pre-core mutants have more detrimental effect on the course of chronic HBV infection.

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