title: Significance of liver histology in HBsAg-positive, IgM anti-HBc-negative acute hepatitis B virus-related hepatitis.
abstract: OBJECTIVE
  The natural course of HBsAg-positive, IgM anti-HBc-negative acute hepatitis B virus (HBV)-related hepatitis is unclear. The aim of this study was to evaluate the prognostic significance of histological features and hepatic expression of HBV antigens in such patients.
  
  
  RESULTS
  Fifty patients with HBsAg-positive, IgM anti-HBc-negative acute hepatitis B who underwent liver biopsy during the acute hepatitis episode were studied [HBeAg seroconversion (n = 16), persistently positive for HBeAg (n = 9), and persistently negative for HBeAg (n = 25)]. Twenty-six cases had features of typical acute hepatitis only (group A), and 24 cases had changes suggesting pre-existing chronic hepatitis (group B). HBcAg and/or HBsAg immunoreactivity was detected less frequently in group A than in group B (31% versus 79%, P = 0.01). HBsAg clearance was observed in 24% of patients, almost exclusively in cases with HBeAg seroconversion. HBsAg loss was significantly more frequent in group A than in group B (52% versus 0%, P < 0.001), and in cases without rather than with immunohistochemical expression of HBV antigens (55% versus 0%, P < 0.001). In group A, HBsAg clearance was observed in 80%, 54% and 0% of patients with mild, moderate or severe acute hepatitis, respectively (P < 0.034).
  
  
  CONCLUSIONS
  Histological information is very important for the prognosis of HBsAg-positive, IgM anti-HBc-negative acute hepatitis B. HBeAg seroconversion with underlying typical acute hepatitis changes of mild to moderate severity without hepatic expression of HBV antigens strongly predicts subsequent HBsAg loss.
authors.affiliation: 1st Department of Pathology 2nd, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Delladetsima
authors.forename: George V
authors.initials: GV
authors.lastname: Papatheodoridis
authors.forename: Dina G
authors.initials: DG
authors.lastname: Tiniakos
authors.forename: Angelos
authors.initials: A
authors.lastname: Hatzakis
authors.forename: Nikolaos C
authors.initials: NC
authors.lastname: Tassopoulos
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000473:pathology* / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000097:blood / Q000378:metabolism; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000378:metabolism*; D006513:Hepatitis B e Antigens / Q000097:blood; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007150:Immunohistochemistry; D008099:Liver / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D007075:Immunoglobulin M