Symptomatic anti‐HBe positive chronic hepatitis B in taiwan with special reference to persistent HBV replication and HDV superinfection

Ninety‐four patients, who were admitted with symptoms of liver disease and found to be positive for hepatitis B surface antigen and antibody to hepatitis B e antigen (anti‐HBe), were examined for hepatitis B virus (HBV) DNA in serum and immunoglobulin antibody to hepatitis B core antigen and liver biopsies were stained for hepatic hepatitis B core antigen. Of 94 patients, 34 (36%) had evidence of HBV replication and 35 (37%) evidence of hepatitis D virus (HDV) superinfection. Most of the latter two groups of patients (> 70%) had evidence of chronic active hepatitis or active cirrhosis in their liver biopsies. The majority of these patients (> 80%) also had high levels of serum alanine aminotransferase (> 200 U/L) during the acute stage of their illness, and suffered from prolonged hepatic inflammation (> 1 year). Many of the patients (59%) also experienced frequent (1–6 episodes) relapsing exacerbations during a two‐year follow‐up period. Thus, persistent replication or reactivation of HBV and HDV superinfection were the two major causes of clinical exacerbations in anti‐HBe‐positive chronic HBV carriers in Taiwan, and also played an important role in the progression of their liver diseases and unfavorable outcomes.