We determined the frequency of integrated viral DNA in the livers of three woodchucks chronically infected with the woodchuck hepatitis virus before and during 30 weeks of therapy with the nucleoside analog L-FMAU [1-(2-fluoro-5-methyl-beta, L-arabinofuranosyl)uracil, clevudine]. We found that although viral covalently closed circular DNA declined 20-to 100-fold, integrated viral DNA showed no discernable decrease over the course of treatment. Thus, chemotherapeutic clearance of covalently closed circular DNA did not involve the replacement of the infected hepatocyte population with uninfected progenitors, but rather, uninfected hepatocytes in the treated liver were derived from the infected hepatocyte population. The frequency of integrated DNA in chronically infected woodchucks was found to be 1 or 2 orders of magnitude higher than that in transiently infected woodchucks, implying that integration and other genomic damage accumulate over the duration of infection. Our results indicate that genetic changes from this damage remain in the liver even while virus infection is cleared and argue for early antiviral intervention in chronic hepatitis.
C hemotherapy of hepatitis B virus (HBV) infections hasfocused primarily on a strategy of inhibiting viral DNA synthesis through the use of nucleoside analogs that are highly specific for the viral DNA polymerase (1-9). Treatment of patients with such inhibitors can be remarkably effective in reducing viremias to very low levels (2, 3). The reduction of viremia has been shown to occur with biphasic kinetics, with the first phase of rapid reduction attributed to the inhibition of virus production by infected cells, combined with viral clearance from the blood by mechanisms probably unrelated to the action of the drug. The slower second phase has been attributed to the elimination of infected cells from the liver, by either normal or immune-enhanced mechanisms, and the accumulation of uninfected cells (10, 11). The gradual replacement of infected by uninfected hepatocytes has been observed during antiviral therapy of woodchucks chronically infected with the woodchuck hepatitis virus (WHV), an animal model for HBV (7). In 1-(2-f luoro-5-methyl-beta, L-arabinofuranosyl)uracil (L-FMAU)-treated woodchucks, the onset of the reduction in infected cells lags behind the decline of the covalently closed circular DNA (cccDNA), the viral transcriptional template in the nucleus. It has been proposed that the removal of cccDNA occurs by hepatocyte turnover, and that dilution of cccDNA copy numbers in dividing hepatocytes results in eventual segregation of uninfected progeny cells (12). Alternatively, uninfected hepatocytes may arise by differentiation of uninfected progenitors (13) or be generated through a slow loss of cccDNA from infected hepatocytes (14,15).During hepadnavirus infection, a small fraction of hepatocytes undergo recombination with viral DNA molecules in the nucleus and acquire an integrated viral DNA that may be stably retained in that hepatocyte lineage (16)(17)(18)(1...