Acute exacerbation in chronic type B hepatitis: Comparison between HBeAg and antibody‐positive patients

The incidence, clinicopathological features and etiology of acute exacerbation occurring in patients with chronic type B hepatitis were assessed prospectively among 385 patients who had HBeAg and 279 who had anti‐HBe in serum. During an average follow‐up of 23.5 months, acute exacerbations occurred in 197 HBeAg‐positive patients and in 56 anti‐HBe positive patients, with a calculated annual incidence of 28.6 and 10.3%, respectively (p < 0.001). The clinical and laboratory findings of acute exacerbations were similar in the HBeAg‐positive and anti‐HBe positive patients. The mean serum bilirubin and α‐fetoprotein levels were higher in anti‐HBe positive patients (p < 0.01), but actual differences were small. The histologic features of acute exacerbations were also similar in the HBeAg‐positive patients and anti‐HBe positive patients. Lobular alterations were the main histologic findings; in addition, one‐fourth of patients had bridging necrosis and one‐fourth had piecemeal necrosis. Spontaneous reactivation of hepatitis B was the major cause of these exacerbations in both HBeAg‐positive patients (91.5%) as well as anti‐HBe positive patients (62.5%). Hepatitis delta virus superinfection accounted for a higher percentage of exacerbations in anti‐HBe positive patients (14.3%) than in HBeAg‐positive cases (6.5%). Hepatitis A and possibly non‐A, non‐B virus superinfections also contributed to some episodes of exacerbation. Thus, acute exacerbations of disease occurred more frequently in HBeAg‐positive patients than in anti‐HBe positive patients with chronic type B hepatitis, but the clinicopathological features and etiologies were similar.