The relation between preS1
antigen/antibody system and different phases of
hepatitis B virus infection were studied in 425 serum samples from 50
hepatitis B patients before, during and after
antiviral therapy using
interferon alone or in combination with
corticosteroid withdrawal. A typical profile of self-limited acute
hepatitis B was characterized by hepatitis B virus-
DNA clearance using polymerase chain reaction and preS
antigens using monoclonal radioimmunoassays and by antibody responses to the middle and the large HBs
proteins (gp33/gp36 and p39/gp42) using immunoblotting quantitative analysis. After
interferon therapy in patients with protracted
hepatitis B, complete eradication of the virus was observed in 70% of patients, and antibody response directed to middle HBs and large HBs
proteins could be induced. Conversely, this antibody response was never detected in follow-up studies of
chronic active hepatitis B patients who responded well to
antiviral therapy and lost HBs, preS2 and preS1
antigens. Most interesting, in 50% of patients with
HBeAg-positive
chronic active hepatitis B who received combination
therapy and in 67% of patients with anti-HBe-positive
chronic active hepatitis B given
interferon alone, the elevated serum preS1Ag/
HBsAg ratio persisted
after treatment was discontinued and even increased until the end of the follow-up when hepatitis B virus
DNA was undetectable in serum by the conventional hybridization technique. This rebound of preS1
antigen expression following
antiviral therapy in patients with
chronic active hepatitis B may indicate virus persistence, suggesting the possibility of relapse through wild-type hepatitis B virus or the emergence of hepatitis B virus mutants.