Chronic hepatitis B: correlation between viral replication and clinical course

Twenty carriers of hepatitis B virus (HBV) were followed for two to seven years, and their histologic progression was correlated with HBV core-associated DNA polymerase (DNAP) activity as a marker of viral replication. Seventeen patients were divided into two groups according to their pattern of viral replication: group 1, consistently high levels of DNAP; group 2, low levels of DNAP. Chronic persistent hepatitis predominated in group 1; chronic active hepatitis predominated in group 2. The three remaining patients were consistently negative for DNAP. In two patients in group 2, prominent viral replication preceded a transient increase in transaminase levels, as in acute hepatitis. Although groups 1 and 2 were distinct in their patterns of viral replication, they did not differ significantly in histologic progression. Thus, viral replication is related, at least in part, to hepatic cell necrosis but does not correlate closely with progression to liver cirrhosis.