Hepatitis B virus infection: Current status

Overwhelming hepatitis B infection with immunosuppression. Photomicrographs providing evidence that immunosuppression leads to overwhelming infection. A–D: Liver biopsy from a patient who developed severe liver failure after chemotherapy for non-Hodgkin lymphoma, which was ultimately fatal. A: Extensive hepatocyte injury and inflammation involving the portal tract and hepatic lobule. Prominent ground glass cytoplasmic inclusions representing excess HBsAg are present (100× hematoxylin-eosin). B: Severe architectural disruption with intercellular fibrosis and hepatocyte necrosis (fibrosing cholestatic hepatitis) (100× Masson trichrome stain). C: Immunohistochemical stain for HBsAg confirming the overwhelming burden of HBsAg giving diffuse cytoplasmic reactivity in virtually all cells (alkaline phosphatase stain 100×). D: Overwhelming infection is also evident with HBcAg-positive staining in virtually every nucleus and in cytoplasm as well (alkaline phosphatase stain 200×). E, F: In contrast, the same immunohistochemical stains observed above applied to the liver biopsy of a patient with chronic hepatitis B. E: Only a single cell demonstrates immunoreactivity to HBsAg (alkaline phosphatase stain 400×). F: Scattered nuclei are reactive to staining for HBcAg (alkaline phosphatase stain 200×).

An algorithm for the management of chronic hepatitis B. HBV = hepatitis B virus; HBcAg = hepatitis B core antigen; HBsAg = hepatitis B surface antigen; ER = endoplasmic reticulum; cccDNA = covalently closed circular DNA.