title: Rates and risk factors for hepatitis B reactivation in a cohort of persons in the inactive phase of chronic hepatitis B-Alaska, 2001-2010.
abstract: BACKGROUND
  A high prevalence of reactivation of hepatitis B has been documented among immunosuppressed individuals in the inactive phase of chronic hepatitis B; However, the proportion of and the risk factors for reactivation are largely unknown among non-immunosuppressed persons.
  
  
  OBJECTIVE
  Estimate the incidence rate of and risk factors for hepatitis B reactivation in a population-based cohort of persons in the inactive phase of chronic hepatitis B in Alaska.
  
  
  METHODS
  A cohort of 414 Alaska Native Persons in the inactive phase of hepatitis B (HBV DNA<2000 IU/mL and normal alanine aminotransferase (ALT) for 12 months) was followed-up for 10 years. Reactivation of hepatitis B was defined as HBV DNA≥2000 IU/mL and ALT≥40 IU/L. Cox-proportional hazards regression models were used to identify factors associated with reactivation.
  
  
  RESULTS
  A total of 36 (9%) persons had reactivation during 2984 person-years of follow-up, with an annual incidence of 1.2%. Persons aged ≥50 years (1.8%) at study entry had the highest incidence rates of reactivation although incidence rates were not significantly different by age group. Risk factors for hepatitis B reactivation were male sex (Hazard Ratio (HR)=2.41; 95% Confidence Interval (CI): 1.17-4.96), HBV DNA≥1000 IU/mL at study entry (HR=7.61; 95% CI: 2.81-20.6), and HBV genotype B (HR=6.08; 95% CI: 1.32-28.0).
  
  
  CONCLUSIONS
  The incidence of hepatitis B reactivation was low during the 10 years of follow-up. However, given the higher risk of reactivation than their counterparts, males, and those with HBV DNA≥1000 IU/mL need to be followed-up more frequently.
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: rtohme@cdc.gov.
authors.forename: Rania A
authors.initials: RA
authors.lastname: Tohme
authors.forename: Lisa
authors.initials: L
authors.lastname: Bulkow
authors.forename: Chriss E
authors.initials: CE
authors.lastname: Homan
authors.forename: Susan
authors.initials: S
authors.lastname: Negus
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McMahon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000413:Alaska; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006515:Hepatitis B virus / Q000254:growth & development*; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D012307:Risk Factors; D014775:Virus Activation; D055815:Young Adult
keywords: AASLD; AFP; ALT; AST; American Association for the Study of Liver Disease; BMI; CI; DNA; HBV; HBeAg; HBsAg; HCC; HR; Hazard Ratio; Hepatitis B; Incidence; NIH; National Institutes of Health; PCR; Reactivation of infection; Risk factors; SD; alanine aminotransferase; alpha-fetoprotein; anti-HBc; anti-HBe; anti-HBs; antibody to hepatitis B core; antibody to hepatitis B surface antigen; antibody to hepatitis e antigen; aspartate aminotransferase; body mass index; confidence interval; deoxyribonucleic acid; hepatitis B e antigen; hepatitis B surface antigen; hepatitis B virus; hepatocellular carcinoma; polymerase chain reaction; standard deviation.