Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3953
Peer-review started: August 17, 2014
First decision: September 15, 2014
Revised: October 7, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: April 7, 2015
Core tip: Distinguishing between acute hepatitis B (AHB) and chronic hepatitis B with acute exacerbation (CHB-AE) is important because of the different prognosis and treatment strategy. However, distinguishing AHB and CHB-AE is difficult due to their similar clinical features and serologic profiles, especially in patients with IgM anti-HBc positivity. This is the first study to differentiate between AHB and CHB-AE in a distinct group of subjects with positive IgM anti-HBc. The quantitative determination of IgM anti-HBc was useful for differentiating AHB from CHB-AE in patients IgM anti-HBc positive. The combination of serum IgM anti-HBc ≥ 8 S/CO ratio with HBV-DNA levels < 5.5 log10 IU/mL could effectively distinguish AHB from CHB-AE.