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RATIONAL USE OF POLYMERASE CHAIN REACTION - BASED DETECTION OF
VIRAL GENOMES IN PATIENTS WITH SEROLOGIC MARKERS OF HEPATITIS B OR
HEPATITIS C VIRUS-INFECTION
We studied the value of additional diagnostic information
obtained by detection of hepatitis B virus (HBV) DNA or hepatitis C
virus (HCV) RNA using the qualitative polymerase chain reaction
(PCR) in patients with serologic markers of hepatitis B or
hepatitis C virus infection. In HBV infection, all HBsAg+HBeAg+
patients and all HBsAg+HBeAg- patients with alanine
aminotransferase (ALT) levels > 100 U/L were positive for
HBV-DNA by PCR, whereas in HBsAS+HBeAS- patients with ALT < 100
U/L 58% and in HBsAg+HBeAg- patients with normal aminotransferase
45% were found to be positive. In HBsAg+ patients no further
clinically useful information can be obtained by PCR as the
presence of HBsAg proves infection. However, in three of 42 (7%)
patients with markers of past HBV infection (antiHBs and/or
antiHBc+) HBV-DNA was detected in the serum. Similarly, in some
patients with acute hepatitis B HBV-DNA was demonstrable up to four
months after the disappearance of HBsAg from serum, pointing to
persistence of viremia despite the loss of serological markers of
ongoing HBV infection. Demonstrating ongoing HBV infection in
patients with serological markers of past infection is valuable
additional information in only selected patients. In HCV infection,
10% of anti-HCV+ patients with increased ALT levels had a negative
serum HCV-RNA. However, in 20% of those patients HCV-RNA was
demonstrated in a serum sample collected later during follow-up,
indicating that a single negative HCV-RNA determination cannot be
taken as evidence for the resolution of infection.
Author: C MULLER, UNIV VIENNA, KLIN INNERE MED 4, WAHRINGER
GURTEL 18-20, A-1090 VIENNA, AUSTRIA
Source: WIENER KLINISCHE WOCHENSCHRIFT 1997
JAN17;109(1):20-24
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