Evidence of viral replication in HBsAg positive patients with hepatocellular carcinoma: measurement of serum hepatitis B virus deoxyribonucleic acid (HBV-DNA).

Sera from 60 consecutive patients with hepatocellular carcinoma (HCC) diagnosed by either a positive histology or at least two of the following: CT scan, hepatic ultrasound, hepatic angiogram and raised alpha-foetoprotein levels, were studied to determine their Hepatitis B surface antigen (HBsAg) status and the frequency of continuing viral replication. Markers of Hepatitis B virus (HBV) infection were detected using enzyme and radioimmunoassays. Hepatitis B DNA (HBV-DNA) was measured by molecular hybridization using a labelled recombinant HBV-DNA probe. Sera from 30 HBsAg positive 'healthy' carriers were used as controls. Forty-seven (78%) patients were HBsAg positive. Evidence of previous HBV infection was present in 12 of 13 HBsAg negative patients. 30% of HBsAg positive patients were HBeAg positive, 62% were anti-HBe positive and 8% had no 'e' markers. Serum HBV-DNA was present in 21 (45%) HBsAg positive patients: 10 (71%) HBeAg positive patients, 10 (35%) anti-HBe positive patients and 1 (25%) patient without any 'e' markers. Serum HBV-DNA levels were less than 0.6 ng/ml in 16 (76%) patients. HBV-DNA was absent in all HCC patients who were HBsAg negative. The frequency of serum HBV-DNA positivity was higher in 30 patients with HCC when compared with 30 age and sex matched healthy HBsAg positive individuals (57% vs 13% p less than 0.01). A sizeable proportion of HBsAg positive HCC patients have on-going viral replication and this is present in patients who were thought to have stopped replicating (anti-HBe positive patients).(ABSTRACT TRUNCATED AT 250 WORDS)