Distinguishing between acute and symptomatic chronic hepatitis B virus infection.
OBJECTIVE
Differentiating between an acute hepatitis B (AH-B) infection and an acute exacerbation of a chronic hepatitis B (CH-B) infection can present a problem for the clinician. The only current serological method of distinguishing between acute and symptomatic chronic hepatitis B virus (HBV) infection is the immunoglobulin M antibody to hepatitis B core antigen (anti-HBc) assay, which can be problematic. Therefore, in an attempt to better distinguish between acute and chronic HBV infection, sera from 26 patients with AH-B and 53 patients with CH-B were compared in a variety of experimental immunoassays.


METHODS
Experimental assays have been designed to detect free antibody to hepatitis B e antigen (anti-HBe), hepatitis B e antigen (HBeAg)/anti-HBe immune complexes (ICs), and hepatitis B surface antigens (HBsAg)/antibody to hepatitis B surface antigen (anti-HBs) in the presence of excess antigen. An additional assay was developed to detect a novel anti-HBc specificity, designated antibody to woodchuck hepatitis virus (anti-HBcW), which cross-reacts with the core antigen of the woodchuck hepatitis virus.


RESULTS
Sera from patients with CH-B showed significantly higher levels of free anti-HBe, HBeAg/anti-HBe ICs, and HBsAg/anti-HBs ICs compared with AH-B patient sera. Furthermore, patients with CH-B consistently produced high titer anti-HBcW, whereas patients with AH-B produced little or no anti-HBcW antibody.


CONCLUSIONS
The serology of AH-B infection and symptomatic CH-B infection can be distinguished using a variety of experimental immunoassays in addition to the immunoglobulin M anti-HBc assay.
Maruyama
T
T
Department of Molecular Biology, Scripps Research Institute, La Jolla, California.
Schödel
F
F
Iino
S
S
Koike
K
K
Yasuda
K
K
Peterson
D
D
Milich
D R
DR
D000208:Acute Disease; D000818:Animals; D000917:Antibody Formation; D000936:Antigen-Antibody Complex / Q000032:analysis; D002908:Chronic Disease; D003429:Cross Reactions; D003937:Diagnosis, Differential; D000939:Epitopes; D006509:Hepatitis B / Q000175:diagnosis* / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000032:analysis / Q000276:immunology; D006512:Hepatitis B Core Antigens / Q000032:analysis / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006513:Hepatitis B e Antigens / Q000032:analysis / Q000276:immunology; D006520:Hepatitis, Animal / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D008392:Marmota / Q000276:immunology
D000936:Antigen-Antibody Complex; D000939:Epitopes; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D007074:Immunoglobulin G; D007075:Immunoglobulin M