Predictive factors for reactivation of hepatitis B following hepatitis B e antigen seroconversion in chronic hepatitis B

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 133; no. 5; p. 1458
• Main Authors: Chu, Chia-Ming, Liaw, Yun-Fan
• Format: Journal Article
• Language: English
• Published: United States 01.11.2007
• Subjects: Adult; Alanine Transaminase - blood; Cohort Studies; Female; Genotype; Hepatitis B e Antigens - blood; Hepatitis B e Antigens - immunology; Hepatitis B virus - genetics; Hepatitis B virus - immunology; Hepatitis B virus - physiology; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - genetics; Hepatitis B, Chronic - immunology; Humans; Male; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Sex Characteristics
• ISSN: 1528-0012
• DOI: 10.1053/j.gastro.2007.08.039

Predictors of reactivation of hepatitis B following hepatitis B e antigen (HBeAg) seroconversion in chronic hepatitis B have rarely been reported before and deserve further study. A total of 133 HBeAg-positive asymptomatic carriers who have undergone HBeAg seroconversion were studied. Reactivation of hepatitis B was defined as elevation of alanine aminotransferase >2 x upper normal limit accompanied by serum hepatitis B virus DNA detectable by hybridization assays. The samples consisted of 75 men and 58 women, and the mean age at entry was 28.2 +/- 6.9 years. One hundred eight subjects had genotype B, and 25 had genotype C. The maximal alanine aminotransferase levels during the HBeAg-positive phase were <2, 2-5, and >5 x upper normal limit in 49, 40, and 44 subjects, respectively. HBeAg seroconversion occurred after a mean follow-up of 4.6 +/- 3.7 years. During a mean follow-up of 5.8 +/- 4.6 years following HBeAg seroconversion, reactivation of hepatitis B occurred in 26 patients at 3.3% per year. Multivariate analyses demonstrated that reactivation of hepatitis B correlated significantly with genotype C (P = .003), male sex (P = .03), alanine aminotransferase levels >5 x upper normal limit during the HBeAg-positive phase (P = .02), and age at HBeAg seroconversion >/=40 years (P = .002). At baseline, genotype C and male sex are independent factors predictive of reactivation of hepatitis B. Additionally, 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.