Abstract
In countries with intermediate or high endemicity for chronic hepatitis B virus (HBV) infection, exacerbations of chronic hepatitis B (CHB) are common. We studied the clinical, biochemical, and virologic characteristics of patients first presenting clinically with features of acute icteric hepatitis B, to identify features that might differentiate between acute viral hepatitis B (AVHB) from first episode of exacerbation of chronic hepatitis (ECHB). We retrospectively analyzed 79 patients (mean age 35.4 ± 14 years; M:F = 60:19) who first presented clinically as AVHB, within 4 weeks of onset of symptoms. Patients who on follow-up cleared HBsAg and/or did not develop any clinical, radiologic, or histologic evidence of chronic liver disease (CLD) were categorized as AVHB (group 1). Patients who had persistence of HBsAg and developed clinical, biochemical, radiologic, or histologic evidence of chronic liver disease were categorized as ECHB (group 2). Forty-nine patients were in group 1 and 30 in group 2. The 2 groups were comparable with respect to prodrome, onset of jaundice, serum bilirubin, ALT, prothrombin time prolongation, serum albumin, and A/G ratio. Among group 1 patients, 78% had IgM anti-HBc positive in titers > 1:1000; in group 2, there were negative or positive in titers < 1:1000 in 70% patients (P < .001). Forty-seven of 49 (95.9%) patients in group 1 had HBV-DNA levels < 0.5 pg/mL, whereas 26 of 30 (86.73%) patients in group 2 had levels > 0.5 pg/mL (P ≤ .001). Quantitative HBV DNA and IgM anti-HBc titers at initial presentation can differentiate patients with a true episode of acute hepatitis B from patients with first episode of symptomatic exacerbation of chronic hepatitis B. Clinical and biochemical features do not help in differentiating the two.
Similar content being viewed by others
References
Redeker AG: Viral hepatitis: Clinical aspects. Am J Med Sci 270:9–16, 1975
Hoofnagle JH, Seeff CB, Bales ZB: Serologic responses in hepatitis B. In Viral Hepatitis. Vyas GN, Cohen SN, Schmid R, (eds). Philadelphia, Franklin Institute, 1978, pp 219–242
Chu CM, Sheen IS, Liaw YF: The etiology of acute hepatitis in Taiwan: acute hepatitis superimposed upon HBsAg carrier state as the main etiology of acute hepatitis in areas with high HBsAg carrier rate. Infection 16:233–237, 1988
Sherlock S: The natural history of hepatitis B. Postgrad Med J 63(Suppl 2):7–11, 1098
Knodell RG, Ishak KG, Black WC, et al.: Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1:431–35, 1981
Liaw YF, Leung N, Guan R, Lav GK, Merican I: Asia Pacific Consensus Statement on the management of chronic hepatitis B: an update. J Gastroenterol Hepatol 18:239–245, 2003
Liaw YF, Chu CM, Huang MJ, Chen TJ, Lin DY: The etiology of acute viral hepatitis in an endemic area of hepatitis A and B. Am J Trop Med Hyg 32:1401–1406, 1983
Tassopoulos NC, Papaevangelou GJ, Sjogren MH, Karayannis AR, Gerin JL, Purcell RH: Natural history of acute hepatitis B surface antigen positive hepatitis in Greek adults. Gastroenterology 92:1844–1850, 1987
Davis GL, Hoofnagle JH: Reactivation of chronic type B hepatitis presenting as acute viral hepatitis. Ann Intern Med 102:762–765, 1985
Lemon SM, Gates NL, Simms TE, Bancroft WH: IgM antibody to hepatitis B core antigen as a diagnostic parameter of acute infection with hepatitis B virus. J Infect Dis 143:803–809, 1981
Papaevangelov G, Roumeliotou-Karayannis A, Tassopoulos N, Stathopoulou P: Diagnostic value of IgM anti-HBc in high prevalence areas. J Med Virol 13:393–399, 1984
Gupta S, Govindarajan S, Fong TL, Redeker AG: Spontaneous reactivation in chronic hepatitis B: patterns and natural history. J Clin Gastroenterol 12:562–568, 1990
Brzosko WJ, Mikulska B, Cianciara J, Babiuch L: Immunoglobulin class of antibody to hepatitis B core antigen. J Infect Dis 132:1–5, 1975
Webster G, Reignat S, Maini M, et al.: Incubation phase of acute hepatitis B in man: dynamics of cellular immune mechanisms. Hepatology 32:1117–1124, 2000
Chisari FV: Analysis of hepadnavirus gene expression, biology, and pathogenesis in transgenic mouse. Curr Top Microbiol Immunol 168:103–140, 1991
Guidotti LG, Rochford R, Chung J, Shapiro M, Putcell R, Chisari FV: Viral clearance without destruction of infected cells during acute HBV infection. Science 284:825–829, 1999
Levy P, Marcellin P, Peignoux MM, Degott C, Nataf J, Benhamou JP: Clinical course of spontaneous reactivation of hepatitis B virus infection in patients with chronic hepatitis B. Hepatology 12:570–574, 1990
Goyno S, Marcellin P, Loriot MA, et al.: Detection of serum HBV-DNA by polymerase chain reaction (PCR) in patients before reactivation of chronic hepatitis B. J Hepatol 14:357–360, 1992
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kumar, M., Jain, S., Sharma, B.C. et al. Differentiating Acute Hepatitis B from the First Episode of Symptomatic Exacerbation of Chronic Hepatitis B. Dig Dis Sci 51, 594–599 (2006). https://doi.org/10.1007/s10620-006-3175-2
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10620-006-3175-2