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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Chu
Chia-Ming
CM
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan. chiamingchu@yahoo.com.tw
Liaw
Yun-Fan
YF
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005838:Genotype; D006513:Hepatitis B e Antigens / Q000097:blood / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology* / Q000502:physiology*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000235:genetics / Q000276:immunology*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012727:Sex Characteristics
D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase