Background/Aims: Differentiating between an acute hepatitis B (AH-B) i
nfection and an acute exacerbation of a chronic hepatitis B (CH-B) inf
ection can present a problem for the clinician. The only current serol
ogical 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. T
herefore, in an attempt to better distinguish between acute and chroni
c 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 hep
atitis B e antigen (anti-HBe), hepatitis B e antigen (HBeAg)/anti-HBe
immune complexes (ICs), and hepatitis B surface antigen (HBsAg)/antibo
dy 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-H
Bc(w)), which cross-reacts with the core antigen of the woodchuck hepa
titis virus. Results: Sera from patients with CH-B showed significantl
y higher levels of free anti-HBe, HBeAg/anti-HBe ICs, and HBsAg/anti-H
Bs ICs compared with AH-B patient sera. Furthermore, patients with CH-
B consistently produced high titer antiHBc(w), whereas patients with A
H-B produced little or no anti-HBc(w) antibody. Conclusions: The serol
ogy of AH-B infection and symptomatic CH-B infection can be distinguis
hed using a variety of experimental immunoassays in addition to the im
munoglobulin M anti-HBC assay.