LE VARIANTI GENOMICHE DELLA REGIONE PRE-CORE DEL VIRUS DELL'EPATITE B: ASPETTI PATOGENETICI E CLINICI

HBV pre-C variants, containing mutations in the pre-C region which prevent HBeAg expression, have been identified as the prevalent viral population in viremic anti HBe positive carriers. Infection with pre-C variants has important clinical implications since the absence of HBeAg production makes these viruses more resistent to the immune elimination and likely more pathogenic. In fact, pre-C mutants prevail in patients with severe acute and chronic hepatitis B. However, pre-C mutants are not invariably associated with severe liver disease and many other factors can effect the clinical course and outcome of HBV infection, as the competence and genetic heterogeneity of the immune system.