Cryptic hepatitis B virus replication during prednisone therapy in type B chronic active hepatitis.

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Chronic active hepatitis can involve persistent Hepatitis B virus (HBV) replication, even with undetectable hepatitis B e antigen.
• Detecting cryptic HBV replication is crucial for understanding disease progression and treatment efficacy.

Purpose of the Study:

• To investigate the effects of chronic low-dose prednisone administration on HBV replication in patients with chronic active hepatitis and cryptic HBV replication.
• To assess the impact of prednisone therapy on the percentage of HBV-infected liver cells and serum HBV-DNA levels.

Main Methods:

• Utilized spot hybridization for serum HBV-DNA detection and immunoperoxidase staining for liver HBV core antigen.
• Administered low-dose prednisone (10 or 15 mg/day) for a mean of 30 months to 17 patients.
• Performed liver biopsies before and after treatment to quantify infected cells.

Main Results:

• Prednisone therapy led to a significant reduction in the mean percentage of infected liver cells (from 12% to 3.2%).
• HBV replication ceased or decreased in two-thirds of patients, with no observed flare-ups.
• Serum HBV-DNA became undetectable in half of the patients after treatment.
• Five patients developed cirrhosis during the study period despite therapy.

Conclusions:

• Low-dose prednisone therapy can effectively suppress HBV replication in a significant proportion of patients with chronic active hepatitis and cryptic replication.
• Steroid treatment did not prevent the progression to cirrhosis in this patient cohort.
• Further research is needed to explore alternative or combination therapies for preventing HBV-related liver disease progression.