Objective      To study the clinical characteristics of the patients with chronic severe hepatitis B (CSH) and human cytomegalovirus (HCMV) infection

and the distribution of HCMV genotypes.       Methods      We examined the serum HCMV of 132 patients with CSH diagnosed by our hospital among Marc

h

2011 and December

2012

and used nested PCR to amplify the DNA of the peripheral blood mononucleated cell (PBMC) of these patients. Either anti-HCMV IgM positive or HCMV DNA positive was determined as HCMV reactive infection and the patients were then classified into the group of CSH without HCMV activation (n=122) and the group of CSH with HCMV activation (n=10). We analyzed the clinical characteristics of the two groups and their HCMV gB genotypes and constructed a phylogenetic tree accordingly.       Results      (1) In the 132 CSH patients

the positive rate of anti-HCMV IgG and anti-HCMV IgM were 100% and 3.78% (5/132)

respectively. The group of CSH without HCMV activation had the ratio of male to female of 7.7∶1 and two deaths (one case of severe complications and a variety of mixed infection of pathogens and the other case of multiple complications and heart failure). The group of CSH with HCMV activation had a male to female ratio of 4∶1 and no death

with higher incidence rates of spontaneous bacterial peritonitis

ascites

hepatic encephalopathy

and hepatorenal syndrome than the group of CSH without HCMV activation. (2) The MELD scores of the two groups were not significantly different (

P

=0.783). The AFP level of the group of CSH without HCMV activation was significantly higher than that of the group of CSH with HCMV activation (median value 101.75 vs 27.19

P

=0.024). (3) HCMV DNA positive rate was 5.3% (7/132)

in which gB1 accounted for 85.71% (6/7) and gB3 14.29% (1/7)

with no detection of gB2 or gB4. Both anti-HCMV IgM and HCMV DNA were positive in two cases.       Conclusion      There is a lower proportion of active HCMV infection in the patients with CSH. HCMV DNA detection rate is higher than serological IgM detection rate

with gB1 as the major genotype. Accompanying with HCMV reactive infection may affect the clinical outcome of CSH patients.