Hepatitis Reactivation Following HBeAg Seroconversion

Chronic hepatitis B patients who experience hepatitis B "e" antigen (HBeAg) seroconversion typically have better outcomes than those who remain HBeAg positive, including a lower risk of developing liver cirrhosis and hepatocellular carcinoma. However, some individuals with HBeAg loss may still experience hepatitis B reactivation.

In the November 2007 issue of Gastroenterology, researchers from Taiwan studied 133 previously HBeAg positive asymptomatic HBV carriers (75 men, 58 women; mean age 28 years) who experienced HBeAg seroconversion; 108 had HBV genotype B and 25 had genotype C.

During the HBeAg positive phase, 49 subjects had maximal alanine aminotransferase (ALT) levels < 2 x the upper limit of normal (ULN), 40 had ALT 2-5 x ULN, and 44 had ALT > 5 x ULN. Reactivation of hepatitis B was defined as ALT elevation to > 2 x ULN, accompanied by detectable serum HBV DNA by hybridization assay.

Results

• HBeAg seroconversion occurred after a mean follow-up period of 4.6 years.

• During a mean follow-up period of about 6 years following HBeAg seroconversion, 26 patients experienced hepatitis B reactivation (3.3% per year).

• Multivariate analyses showed that hepatitis B reactivation was significantly correlated with:

• HBV genotype C (P = 0.003);
• Male sex (P = 0.03);
• ALT > 5 x ULN during the HBeAg positive phase (P = 0.02);
• Age > 40 years at the time of HBeAg seroconversion (P = 0.002).

Conclusion

Based on these findings, the study authors concluded that, "[HBV] genotype C and male sex are independent factors predictive of reactivation of hepatitis B."

Additionally, they wrote, "the likelihood of reactivation of hepatitis B is increased if more rigorous immune-mediated hepatocytolysis or more prolonged immune clearance phase is necessary to eliminate the virus."

Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.

12/14/07

Reference
CM Chu and YF Liaw. Predictive Factors for Reactivation of Hepatitis B Following Hepatitis B e Antigen Seroconversion in Chronic Hepatitis B. Gastroenterology 133(5): 1458-1465. November 2007.