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<p>Abstract</p> <p>Acute viral hepatitis B is cleared in more than 95% of patients, while the remainder ones may develop either chronic HBV infection or, rarely, fulminant hepatitis.</p> <p>Therefore there are elderly patients with severe acute HBV hepatitis caractherized by high serum bilirubin levels >15 mmole/dl, international normalized ratio (INR) with value more than 1.6; these patients are caractherized by a severe outcome of HBV infection.</p> <p>As known, outcome of infection and the pathogenesis of liver diseases are determined by viral and host factors, such as T reg lymphocytes.</p> <p>T regs may be associated with a negative immune response such as an inhibition of gamma- IFN secretion.</p> <p>The impact of viral load on antiviral T cell responses may play a critical role in thaese patients, influencing disease persistence and immune response.</p> <p>Antiviral drugs could be useful in these patients determing a possible down -regulation of T regs.</p>