High rate of core promoter and precore mutations in patients with chronic hepatitis B

• Published in: Hepatology international 2015-04, Vol.9 (2), p.209-217
• Main Authors: Baqai, Sumbella F., Proudfoot, James, Yi, Debbie H., Mangahas, Michael, Gish, Robert G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Alanine Transaminase - blood; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - enzymology; Carcinoma, Hepatocellular - virology; Colorectal Surgery; Cross-Sectional Studies; DNA, Viral - blood; Female; Hepatitis B e Antigens - blood; Hepatitis B virus; Hepatitis B virus - genetics; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - virology; Hepatology; Humans; Liver Cirrhosis - blood; Liver Cirrhosis - virology; Liver Neoplasms - blood; Liver Neoplasms - enzymology; Liver Neoplasms - virology; Male; Medicine; Medicine & Public Health; Middle Aged; Mutation; Original; Original Article; Promoter Regions, Genetic; Retrospective Studies; Severity of Illness Index; Surgery; United States; Young Adult
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-014-9598-5

Background The prevalence of precore (PC) and core promoter (CP) mutations in patients with chronic hepatitis B virus (HBV) infection (CHB) and their impact on liver disease is incompletely defined in the United States. Methods A retrospective chart review using a cross-sectional approach of 1,186 CHB patients was conducted. Results Of 926 patients tested for HBV e antigen (HBeAg), 37 % were HBeAg+. Of 194 patients tested for mutations, 80 % had PC or CP mutations or both; 89 % of HBeAg-negative and 56 % of HBeAg+ patients had PC or CP mutations or both ( p   2 × ULN compared to patients with ALT ≤ 0.5 × ULN. Conclusions Our finding that PC and CP mutations may be associated with milder liver disease in some patients could serve as the basis for longitudinal studies to help delineate treatment need and duration in patients with these mutations. If confirmed, the finding of an association between ALT 1–2 × ULN and increased incidence of cirrhosis could call into question guidelines which only recommend treatment with ALT > 2 × ULN.