Pattern and duration of HBV DNA seropositivity in acute hepatitis B

To determine the pattern and duration of HBV DNA seropositivity in acute hepatitis B, six patients were assessed during the incubation, clinical, and convalescent stages of their illness by DNA hybridization using a slot blot technique. Patients were identified by the detection of HBsAg nearly one month before the development of clinical and laboratory features of acute hepatitis (mean 22 +/- 4 days) and they were followed at one- to three-week intervals for 6 +/- 1 months. Each patient lacked antibody to delta virus. During the incubation period, HBV DNA was not detected in serum. At symptomatic onset, all were seropositive for HBV DNA and HBeAg. At peak biochemical disease, three patients had already cleared HBV DNA and five continued to harbor HBeAg. The duration of HBV DNA seropositivity was as short as one week. At the time of biochemical resolution, all patients had cleared HBV DNA, while four of five remained HBeAg-positive. Clearance of HBeAg and HBsAg occurred 4 +/- 2 months after loss of HBV DNA. We conclude that HBV DNA is not detectable in serum during the early incubation period but that it is present at the onset of symptoms. Its duration in serum can be brief and clearance is possible by the peak of aminotransferase activity. HBV DNA usually disappears before HBeAg, and it is invariably lost by the time of biochemical resolution. Its detection in serum coincides with the clinical illness, but it may be missed unless sampling is done early in the clinical course.