Eleven patients of Chinese origin experienced spontaneous reactivation of chronic active hepatitis B. Eight
HBsAg-positive patients were followed for an average of 15 months prior to, while three others presented during reactivation. Fatigue, hepatomegaly and jaundice were frequent findings. Elevation of both serum ALT (average = 1,212 units per liter) and hepatitis B virus DNA levels were noted in all patients, and reactivation lasted an average of 4.4 months. During resolution, clinical symptoms abated, serum ALT levels reverted toward normal, and in nine patients, the hepatitis B virus DNA values became undetectable. All patients lacked evidence for acute hepatitis A, Epstein-Barr Virus, cytomegalovirus or hepatitis delta virus infection.
Histologic findings of liver tissue from eight patients showed piecemeal necrosis and fibrosis. Within the parenchyma, varying degrees of hepatocytolysis with cuffing, perivenular necrosis and acidophilic bodies were noted. Ground-glass cells and regenerative changes also were observed. Cirrhosis was not present in any of the liver biopsies.
These findings suggest that spontaneous reactivation of hepatitis B occurs in heterosexual patients with chronic active hepatitis B and contributes to chronic inflammation and to the progression of their liver disease.
Chronic active hepatitis B (CAH-B) is a progressive disease which ultimately leads to cirrhosis and possible development of primary hepatocellular carcinoma (PHC). Approximately 3% of adult patients who contract acute icteric hepatitis go on to CAH-B (1). However, the majority of CAH-B patients who present to the physician have no previous history of jaundice or hepatitis, and presumably acquire their disease via a subclinical infection. In Asian countries, this may occur by neonatal transmission from an asymptomatic HBsAg-positive mother to her infant or exposure to hepatitis B during early childhood.
Four long-term follow-up studes of adult patients with CAH-B have shown that, during a mean follow-up of 49 months, 42% of 136 patients had clinical and biochemical