Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 14, 2008; 14(46): 7133-7137
Published online Dec 14, 2008. doi: 10.3748/wjg.14.7133
Acute hepatitis B or exacerbation of chronic hepatitis B-that is the question
Efrat Orenbuch-Harroch, Liran Levy, Eldad Ben-Chetrit
Efrat Orenbuch-Harroch, Liran Levy, Eldad Ben-Chetrit, Department of Medicine A, Hadassah-Hebrew University, Medical Center, Jerusalem 91120, Israel
Author contributions: Ben-Chetrit E had full access, to all the data in the study and takes responsibility for the integrity of the data; Orenbuch-Harroch E and Ben-Chetrit E design the study; Orenbuch-Harroch E, Levy L, and Ben-Chetrit E wrote the paper.
Correspondence to: Eldad Ben-Chetrit, MD, Professor, Department of Medicine A, Hadassah-Hebrew University, Medical Center, PO Box 12000, Jerusalem 91120, Israel.
Telephone: +972-2-6777111 Fax: +972-2-6777394
Received: September 10, 2008
Revised: October 29, 2008
Accepted: November 6, 2008
Published online: December 14, 2008

Hepatitis B virus (HBV) infection constitutes a serious global health problem. In countries with intermediate or high endemicity for HBV, exacerbations of chronic hepatitis B may be the first presentation of HBV infection. Some of these patients may be diagnosed mistakenly as having acute hepatitis B. Accurate diagnosis in these cases is very important for deciding whether to start treatment or not, because acute hepatitis B does not require therapy, while exacerbation of chronic hepatitis may benefit from it. Clinical and routine laboratory findings cannot help distinguishing between these two conditions. Therefore, several assays have been proposed for this purpose during the last few years. The presence of high levels of anti-HBe antibodies, HBsAg and HBV DNA are typical of chronic disease, whereas high titers of IgM anti-HBc, together with their high avidity index, characterize acute HBV infection. Starting from the description of a patient with acute hepatitis B-who recently came to our observation-we critically review the currently available assays that may help distinguishing between the different conditions and lead to the optimal management of each patient.

Keywords: Hepatitis B, Anti-hepatitis B virus antibodies, Hepatitis B virus, Toxic hepatitis, autoimmune hepatitis