Causes of acute exacerbations of chronic hepatitis B.
The authors analyzed acute exacerbations of chronic hepatitis B in 24 chronic HBsAg carriers (20 with positive HBeAg, 4 with anti-HBe), more than half of whom were treated with glucocorticoids, by examining specific antigens and antibodies of the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis delta virus (HDV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Of 38 observed exacerbations of the disease they found in 7 (18%) deterioration after discontinuation of glucocorticoids, in 7 (18%) seroconversion of HBeAg to anti-HBe, in 9 (24%) spontaneous exacerbation of chronic hepatitis B, in 11 (29%) chronic activation, reactivation of EBV superinfection, in 3 (8%) CMV reactivation or superinfection and in one (3%) HDV superinfection. In no instance HAV superinfection was observed. Exacerbations were found five times more frequently in subjects in the stage of active viral replication (in HBeAg+ subjects) than in subjects with anti-HBe. In eight patients EBV reactivation was found after glucocorticoids withdrawal: in five patients after an average period of 5 months (range 3-7) and in three patients after an average period of 33 months (range 22-48). The results provide evidence that in addition to already known causes of acute exacerbations of chronic hepatitis B in our geographical area probably an important cause of deterioration of hepatitis is reactivation or superinfection with EBV and CMV in some patients in conjunction with previous glucocorticoid treatment.
Stránský
J
J
1st Internal Clinic of 3rd Medical Faculty of Charles University, Prague, Czech Republic.
Benda
R
R
Vodák
M
M
Zikmundová
L
L
Honzáková
E
E
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000032:analysis; D002908:Chronic Disease; D003587:Cytomegalovirus / Q000276:immunology; D005260:Female; D006508:Hepatitis Antibodies / Q000032:analysis; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006526:Hepatitis C / Q000276:immunology / Q000503:physiopathology* / Q000821:virology; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged
D000914:Antibodies, Viral; D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens