X Region Deletion Variants of Hepatitis B Virus in Surface Antigen-Negative Infections and Non-A, Non-B Hepatitis

The etiology of non-A, non-B hepatitis (NANBH) in renal dialysis patients was determined. Hepatitis C virus was present in many, but its appearance did not correlate with elevated alanine aminotransaminase. When sera from these patients were tested for antibodies against hepatitis B virus (HBV) X antigen and polymerase, 70% were positive. HBV infection was confirmed by polymerase chain reaction using several HBV-specific primer pairs. However, amplification with X region primers failed to yield products in many patients. Cloning and sequencing of these products demonstrated deletions within the X region. Hence, X-deletion variants of HBV are strongly associated with NANBH in renal dialysis patients.