Hepatitis B virus persistence after recovery from acute viral hepatitis

Contrary to current opinion, the disappearance of hepatitis B surface antigen (HBsAg) from the serum, the development of anti-HBs antibodies, and normalization of liver function may not reflect complete virological recovery from acute hepatitis B virus (HBV) infection. By using the polymerase chain reaction (PCR), in the current study we demonstrate long-term persis-tence ofHBV DNA in the serum and peripheral blood mononu-clear cells (PBMC) of four patients for up to 70 mo after com-plete clinical, biochemical, and serological recovery from acute viral hepatitis. Serum HBV DNA reactivity co-sedimented with HBsAg in sucrose gradients, and it displayed the size and density characteristics of naked core particles and intact HBV virions, presumably contained within circulating immune com-plexes in these anti-HBs antibody-positive sera. HBV DNA was also present in PBMC in late convalescent samples from all four patients, and HBV RNA was detected in late convales-cent phase PBMC in two of these patients. These results sug-gest that HBV DNA, and possibly HBV virions, can be present in the serum, and that the viral genome can persist in a tran-scriptionally active form in PBMC for> 5 yr after complete clinical and serological recovery from acute viral hepatitis. (J