The etiology of acute hepatitis superimposed upon previously unrecognized asymptomatic HBsAg carriers

• Published in: Hepatology (Baltimore, Md.) Md.), 1989-03, Vol.9 (3), p.452-456
• Main Authors: Chu, Chia‐Ming, Liaw, Yun‐Fan, Pao, Chia C., Huang, Miau‐Ju
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Biological and medical sciences; Carrier State; DNA, Viral - analysis; Female; Hepatitis - etiology; Hepatitis B e Antigens - analysis; Hepatitis B Surface Antigens - analysis; Hepatitis B virus - genetics; Hepatitis C - immunology; Hepatitis D - immunology; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Viral diseases; Viral diseases of the digestive system
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.1840090319

To study the etiology of acute hepatitis superimposed upon previously unrecognized asymptomatic HBsAg carriers, paired sera were collected in acute and convalescence phases for measurement of HBeAg, anti‐HBe, hepatitis B virus DNA and anti‐delta from 76 adult patients with acute hepatitis who were HBsAg positive but IgM anti‐HBc negative or positive only at low titer. None of them were IgM anti‐hepatitis A virus positive on admission. Of the 34 patients who were HBeAg positive initially, two (5.9%) were diagnosed as having delta superinfection, and another two (5.9%) were suspected to have non‐A, non‐B virus superinfection because of a transient decrease of serum hepatitis B virus DNA. The remaining 30 (88.2%) cases were hepatitis B virus DNA negative with or without anti‐HBe seroconversion on follow‐up. The episodes of acute hepatitis in these cases may represent “immune clearance of HBeAg” or “immune clearance of hepatitis B virus with delayed anti‐HBe seroconversion,” respectively, in the natural course of chronic hepatitis B virus infection. Of the patients who were anti‐HBe positive initially, 23 (54.8%) were diagnosed as having delta superinfection, including eight with de novo seroconversion of anti‐delta and 15 with a rising titer of anti‐delta; 10 (23.8%) were positive for hepatitis B virus DNA and were considered as reactivation of hepatitis B virus, and the other nine (21.4%) were suspected as having non‐A, non‐B virus superinfection. We conclude that the vast majority of episodes of acute hepatitis in HBeAg carriers may represent immune clearance of hepatitis B virus in the natural history of chronic hepatitis B virus infection, and, by contrast, in anti‐HBe carriers they are usually the result of superinfection with other non‐B viruses, the majority of which are due to delta superinfection.