Detection of HBV-DNA in liver biopsy and serum: its significance in the selection of hepatitis B patients for antiviral therapy

We have characterized the hepatitis B virus state in liver and serum of 38 HBsAg-positive chronic hepatitis patients (chronic active hepatitis (CAH), 19; chronic persistent hepatitis (CPH), 7; cirrhosis, 11; 'normal' carrier, 1) and 21 HBsAg-negative patients. Episomal HBV-DNA in liver, without detectable integrated HBV-DNA sequences, concomitant with HBV-DNA in serum was found in 19 HBeAg-positive patients (CAH, 16; CPH, 1; cirrhosis, 2). Integrated sequences were detected in 13 HBsAg-positive HBeAg-negative patients (CAH, 1; CPH, 5; cirrhosis, 7) and in 1 HBsAg-negative patient. Episomal HBV-DNA and integrated HBV-DNA sequences were observed simultaneously in 1 HBsAg-positive HBeAg-negative CPH patient and in 4 HBsAg-positive cirrhosis patients (2 HBeAg-positive, 2 HBeAg-negative). The presence of HBcAg immunofluorescence corresponded well with that of episomal HBV-DNA. Antiviral therapy is advised for HBsAg-positive chronic hepatitis patients with episomal HBV-DNA, irrespective of the presence of integrated sequences. Since the presence of episomal HBV-DNA in liver is not always accompanied by the presence of serum HBV-DNA, procedures for the selection and evaluation of patients for antiviral therapy should be extended by characterization of the HBV-DNA state in liver biopsies.