Serum levels of hepatitis B virus specific
DNA polymerase and
hepatitis B e antigen were studied serially in 34 patients with hepatitis B virus infection--20 who had the acute illness and recovered, seven who died with fulminant disease, three who died as a result of subacute hepatic
necrosis, and four who went on to develop
chronic active hepatitis.
DNA polymerase activity was present in 16 (80%) and
HBeAg in 13 (65%) of the uncomplicated cases at presentation and in all of those patients from whom the initial sample was obtained before the peak in
aminotransferase. Both markers disappeared after 30 days from the onset but
DNAP remained persistently positive during a follow-up period of four to 10 months in the four patients who progressed to
chronic hepatitis. These results indicate that
DNAP and
HBeAg are transiently present in all cases of acute
hepatitis B. Only their persistence after the acute episode could represent a useful prognostic marker of chronically. In this respect,
DNAP was more reliable in our patients than
HBeAg. In uncomplicated acute
hepatitis, the peak in
DNAP levels, which defines the time of maximum virus replication in the liver, preceded the peak in
aminotransferase levels. Among the 10 patients who developed massive liver damage after
hepatitis B infection,
DNAP was detected in five of the seven with fluminant
hepatitis, with
enzyme levels that were comparable with those observed in uncomplicated acute
hepatitis and presentation, but not in the cases of subacute hepatic
necrosis. These findings are consistent with the hypothesis that in
hepatitis B infection, liver damage, whatever the severity, is not directly related to the degree of virus replication.