CD4+ T‐helper cell (Th) responses to hepatitis B virus (HBV) core antigen (HBc) are increased during exacerbations in acute and chronic hepatitis B (AHB, CHB) and might influence the induction of CD8+ cytotoxic T lymphocytes (CTL) that are important for viral clearance. HBc‐specific proliferative responses and cytokine release of blood mononuclear cells (PBMC) were studied in patients with AHB or CHB, as well as responders and non‐responders to interferon‐α treatment (IFN‐R, IFN‐NR), by [³H]‐thymidine‐uptake, enzyme‐linked immunosorbent assay (ELISA) and Elispot assay and were compared to peptide HBc18–27‐specific CTL precursor frequencies among CD8+ T cells derived from HLA‐A2+ patients. HBc‐specific proliferative PBMC responses and Th frequencies were significantly increased in AHB patients compared with untreated CHB patients. PBMC derived from IFN‐R showed stronger cellular responses than IFN‐NR. Stimulated PBMC from all patient groups secreted significantly more IFN‐γ than IL‐4 indicating Th1/Th0 cell responses. Furthermore, in AHB and IFN‐R patients, high peptide HBc18–27‐specific CTL precursor frequencies closely correlated with strong HBc‐specific Th responses, whereas in untreated CHB and IFN‐NR patients lower CTL frequencies were observed without correlation to Th activities. HBV core‐specific Th‐cell responses appeared to support efficient CTL induction in patients with viral clearance, whereas in chronic HBV carriers quantitatively insufficient Th and CTL responses were observed. This observation could be important for future therapeutic strategies.