Relationship between histology, aminotransferase levels, and viral replication in chronic hepatitis B.

To further clarify whether hepatitis B virus is cytopathic, the degree of hepatic histological activity was assessed and compared with levels of replicating virus in serum and liver of 74 untreated patients with chronic hepatitis B. Male homosexuals (n = 35) had significantly greater levels of DNA polymerase (P less than 0.05) and a trend toward higher hepatitis B virus DNA levels than heterosexuals (n = 39). Significantly greater DNA polymerase and hepatitis B virus DNA levels were observed in homosexuals infected with human immunodeficiency virus than in heterosexuals (P less than 0.005 and P less than 0.01, respectively) or human immunodeficiency virus-negative homosexuals (P less than 0.03 for both). Moreover, a trend was observed for higher grades of hepatitis B core antigen staining in the human immunodeficiency virus-infected population than in the human immunodeficiency virus-negative cohort. Hepatitis B virus DNA and DNA polymerase levels in the 74 patients were inversely related to total histological scores, and the degree of portal infiltrate and periportal necrosis bore an inverse relationship to peripheral markers of viral replication in human immunodeficiency virus-negative homosexuals and heterosexuals. Taken together, the data support the view that hepatitis B virus is not cytopathic because the amount of replicating virus does not directly correlate with the degree of histological activity.