Dynamic Observation On The Special Stage Of Hbv Infection With Serum Truncated Hbv Rna Positive

AIM: Based on our early study, a follow up study was carried out to investigatethe stability of HBV infection in newborns represented with only HBV trRNApositive. In addition, chroniclly infected patients treated with lamivudine werealso monitored to obsearve the dynamic change of HBV trRNA and its clinicalimplication during the anti-HBV therapy.METHODS: Totally 90 HBsAg positive pregnant women were selected and theblood from pregnant women was taken at the time points before HBIG therapyand before the delivery. Blood from newborns was taken within 24h after delivery,and then continue to collect the time points of 1 month, 3 month,6 month, 9month, 12 month. Then trRNA, full-length (fRNA), HBsAg, anti-HBs, HBeAg,anti-HBe, anti-HBc and quantitation of HBV DNA were detected.100 patients treated with lamivudine were monitored in total. Blood sampleswere collected in every 3 months up to 24 months from the onset of the therapy.Then patterns of HBV DNA, HBsAg, HBeAg, ALT, YMDD, HBV X DNA,fRNA and trRNA were detected. RESULTSESULTS: There is no actived"breakthrough"HBV infection was obsearvedduring the 12 months follow up study in newborns with HBV trRNA positiveonly. However, in line with the previous study, positive of trRNA is not relatedwith the administration of HBIG therapy for both mothers and newborns (χ2=1.208,P=0.272；χ2= 2.225,P=0.136), also not related with HBeAg positive inmothers(χ2=0.008,P=0.928；χ2=0.694,P=0.405). But fRNA positive is highlyrelated with HBeAg positive in mothers(χ2=10.565,P=0.001). In addition,fRNA positive is highly related with high level replication of HBV DNA(χ2=21.193,P=0.000), but not trR N A(χ2=4.349,P=0.226；χ2=3.182,P=0.364).All of monitored patients were well responsed to lamivudine therapy after 3to 6 months threatment. HBV DNA and fRNA of all patients decrease quickly tolow level, and became undetectable in 78 patients. HBeAg seroconversion rate is24%. When the therapy stopped after around 12 months therapy, HBV DNA andfRNA was negative in 91 patients, the others also decreased to low level (<105copies/ml). HBeAg seroconversion rate was 28%, ALT values became normal,YMDD variation is negative. However, within folowing 12 months, all patientsrelapse with different HBV DNA level and fluctuating ALT levels, HBeAgrecover rate is 32.12% (9/28). But it is a surprise that trRNA expression wasvery stable during the whole monitoring process from onset of the therapy.CONCLUSION: Within 12 months monitoring, trRNA expression in newbornsfrom chronically infected mothers is not influenced by HBeAg, quantitation ofHBV DNA, and the acceptance of HBIG therapy of mothers. This specialinfection with only trRNA positive is stable, and maybe the pathological basesof"breakthrough"infection in newborns. For chronically infected adults, trRNA is a potential serum marker inpredicting withdrawal relapse during lamivudine therapy.