A second limitation is that the diagnosis of acute hepatitis B was based on a positive IgM anti-HBc and positive HBsAg together with symptoms related to hepatitis B. However, IgM anti-HBc is present in approximately 10%–15% of patients with chronic hepatitis B, especially in CHB with an acute flare-up [21–23]. Here, CD40LG is linked to hepatitis B virus infection.