Preference and significance of HBeAg and anti-HBe, determined by enzyme immunoassay, in patients with acute, chronic and resolved hepatitis B.

HBeAg and anti-HBe were determined by enzyme immunoassay in a prospective longitudinal study of 50 patients with hepatitis B, 43 of whom recovered completely. Followup studies were possible in 37 of the recovered patients and in all 7 non-recovering patients for a median of 5 years. Five of the non-recovering patients could be followed up from the initial acute stage of the disease. HBeAg was present in 17 of 18 recovering patients from whom serum was still available from the early stage of disease (i.e. before peak SGPT levels were reached). The presence of HBeAg was transitory for a median period of one week before the peak SGPT level until it was actually attained. All HBeAg-positive serums contained HBsAg and IgM-anti-HB core as well. 39 of the 43 recovering patients developed anti-HBe, first present after a median period of 2 weeks after peak SGPT. After 5 years 25 of 30 tested patients were still anti-HBe positive, all were HBeAg (and HBsAg) negative. Of the non-recovering patients 2 remained HBeAg-positive for at least 4 years, 4 seroconverted to anti-HBe between 0.5 and 2.5 years after the acute stage of the disease, without apparent correlation with the biochemical activity or the histological diagnosis, and 1 patient already had anti-HBe in the acute stage of the disease. Thus HBeAg is as a rule transiently present in acute hepatitis B, during early stages of the disease. HBeAg has been regarded commonly as a viral constituent. The conversion from HBeAg to anti-HBe in the patients with chronic hepatitis B, however, may cast doubt on this assumption in favour of the hypothesis that the HBe/anti-HBe system is of host origin. Anti-HBe, when present without markers of virus replication, may serve as a sign of previous, completely resolved hepatitis B.