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Open AccessArticle

Long-Term Follow-Up of Acute Hepatitis B: New Insights in Its Natural History and Implications for Antiviral Treatment

1
Department of Biomedical Sciences and Public Medicine, Università Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
2
Virology Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, via Portuense 292, 00149 Rome, Italy
3
Infectious Diseases and Hepatology Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, via Portuense 292, 00149 Rome, Italy
*
Author to whom correspondence should be addressed.
Genes 2018, 9(6), 293; https://doi.org/10.3390/genes9060293
Received: 15 May 2018 / Revised: 4 June 2018 / Accepted: 7 June 2018 / Published: 12 June 2018
Acute hepatitis B infection (AHB) is still a common viral acute hepatitis worldwide. As vaccination, antiviral treatment, and immigration are bound to affect the epidemiological landscape of HBV infections, and some of its aspects need to be investigated: (1) the circulation of vaccine escape mutants and of primary drug resistant strains; (2) the change in HBV genotype prevalence; and (3) the clinical implications of AHB and the probability of chronification. The serological, virological, and clinical parameters of 75 patients, acutely infected by HBV, were gathered for a retrospective study. Long-term follow up, either to complete seroconversion or for up to five years, was possible for 44 patients. Sequence analysis of the reverse transcriptase/HBsAg and precore regions was performed to investigate the molecular epidemiology and pathogenesis of recent infections by HBV. Genotype distribution in AHB in Italian patients was radically different from that of chronic infections, with a dramatic increase of extra-European genotypes (A1, F), suggesting that a proportion of AHBs are currently related to imported strains. None of the documented infections occurred in vaccinated individuals, while HBsAg variants (potentially vaccine escape variants) were rare and less prevalent than in chronic infections. No drug resistant strains were observed. Spontaneous viral clearance occurred in all but three cases. Time to viral clearance was inversely proportional to liver damage, but HBsAg titer on day 28 and, better still, HBsAg decay from day 0 to day 28 after admission, were the best predictors of chronification. They are, thus, potentially useful to guide antiviral treatment to prevent chronic evolution. View Full-Text
Keywords: HBV; HBsAg; acute hepatitis; genotype HBV; HBsAg; acute hepatitis; genotype
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Menzo, S.; Minosse, C.; Vincenti, D.; Vincenzi, L.; Iacomi, F.; Zaccaro, P.; D’Offizi, G.; Capobianchi, M.R. Long-Term Follow-Up of Acute Hepatitis B: New Insights in Its Natural History and Implications for Antiviral Treatment. Genes 2018, 9, 293.

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