title: Causes of acute exacerbations of chronic hepatitis B.
abstract: 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.
authors.affiliation: 1st Internal Clinic of 3rd Medical Faculty of Charles University, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Stránský
authors.forename: R
authors.initials: R
authors.lastname: Benda
authors.forename: M
authors.initials: M
authors.lastname: Vodák
authors.forename: L
authors.initials: L
authors.lastname: Zikmundová
authors.forename: E
authors.initials: E
authors.lastname: Honzáková
mesh_terms: 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
chemical_list: D000914:Antibodies, Viral; D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens