For assessing the histopathological features and its relation to alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in anti-HBe-positive chronic hepatitis B in Babol, north of Iran, liver biopsy samples of 91 anti-HBe-positive chronic hepatitis B virus (HBV) infection with raised ALT were scored according to histological hepatitis activity index (HAI) from March 2000 to July 2003. Seventy-seven males and 14 females with a mean age of 32.24 (+/-11.92) years were studied. Mean ALT and AST levels were 112.5 (+/-98.9) and 69.57 (+/-60.6) IU/l, respectively. Minimal, mild, moderate and severe chronic hepatitis were seen in 35 (38.5%), 49 (53.8%), seven (7.7%) and 0 cases, respectively. There was not any significant difference between HAI and ALT levels of < 60, between 60-79 and > or = 80 IU/l (p = 0.299), but with regard to AST levels, this difference was significant (p = 0.005). This study showed that more than 90% of our cases are in the early stages of the liver disease. Although both serum ALT and AST levels are associated with the activity of hepatitis in HBV carriers, the AST is a better laboratory screening test for finding the severity of liver injury than ALT.