Mutations in precore and core promoter region of HBV in patients with hepatic failure

Objective: To clarify the association of hepatitis Bvirus mutants in precore and core promoter regions inpatients with hepatic failure and HBeAg state.Methods: Precore and core promoter regions of 25HBV isolates from the patients with hepatic failurewere analyzed by polymerase chain reaction （PCR）direct sequencing approach.Results: Precore G-to-A;mutants were identified in16 （64%） of the 25 isolates. The "hot spot" mutationsat A-to-T;and G-to-A;were present together in19 （76%） of the 25 isolates, while C-to-T;and T-to-C;existed in a mutually exclusive manner andmore frequently in hepatic failure with liver cirrhosisgroup than in hepatic failure with chronic hepatitisgroup （100% vs 50%）. Both A;and T;-A;could be found frequently in HBeAg-positive subjects（77.8% and 88.9%）, whereas T;/C;was moreprevalent in anti-HBe-positive subjects than inHBeAg-positive subjects （93.8% vs 33.3%）.Conclusions: The whole frequency of mutations in pre-core and core promoter gene will become more fre-quent as HBV infection is to be persistent. Mutationto T;/C;may be useful as a marker for hepaticfailure. It requires further study whether the mixedinfection of mutants and wilds will develop and affectthe condition of HBeAg in serum along the progres-sion of liver disease.