[Viral replication and hepatic manifestations in 7 cases of periarteritis nodosa associated with hepatitis B virus].

Viral replication was studied in 7 cases of PAN associated with hepatitis B virus (HBV). Serum and liver were strongly positive for markers reflecting HBV replication (constant high levels of HBe Ag, numerous hepatocytes nuclei reactive for HBc Ag, high DNA-polymerase activity). No cases were found to be positive for delta antigen or antibody. Mild biological and histological signs of liver damage were present in all patients but one. In PAN, high replication might lead to continuous stimulation and formation of circulating immune complexes in antigen excess which deposit in vascular walls with subsequent vasculitis. The demonstration of intense and permanent HBV replication could explain the unsatisfactory results observed with steroids and immunosuppressive drugs. Since steroids have been shown to increase HBV replication, this therapy might contribute to the perpetuation of the immunopathogenic process responsible for PAN. A more rational approach should take advantage of new antiviral drugs inhibiting HBV replication as suggested by preliminary beneficial results.