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Todd Heller, MD
St Luke's/Roosevelt Hospital Center New York, NY

JAMA. 1989;262(21):2996.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

I read with interest the recent update and review of delta hepatitis by Dr Hoofnagle.¹ He states, "In acute delta hepatitis, coinfection can be distinguished from superinfection by testing for IgM antibody to hepatitis B core antigen [anti-HBc], the serological marker of acute hepatitis B."

Unfortunately, the ability of IgM anti-HBc to act as a marker of acute hepatitis B does not appear to be so clear-cut. In a review of patients with hepatitis B surface antigen, Lai and colleagues² found that 50% of patients with primary hepatocellular carcinoma, 26% of patients with chronic active hepatitis, and 25% of patients with chronic persistent hepatitis had IgM anti-HBc. IgM anti-HBc has also been noted to persist for as long as 2 years after recovery from an acute infection.^3,4 Lastly, Koike and associates⁵ have shown that as many as 90% of acute exacerbations of chronic hepatitis . . . [Full Text PDF of this Article]

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