title: Is it necessary to delay antiviral therapy for 3-6 months to anticipate HBeAg seroconversion in patients with HBeAg-positive chronic hepatitis B in endemic areas of HBV genotype C?
abstract: OBJECTIVE
  Spontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection.
  
  
  METHODS
  Ninety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels.
  
  
  RESULTS
  Only one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA ≥ 5.1 × 10(7) IU/mL and ALT ≥ 5 × ULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure.
  
  
  CONCLUSIONS
  Spontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection.
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Byung-Cheol
authors.initials: BC
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Yoo-Kyung
authors.initials: YK
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Jwa
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Eun Kwang
authors.initials: EK
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Heung Up
authors.initials: HU
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Soo-Young
authors.initials: SY
authors.lastname: Na
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Sun-Jin
authors.initials: SJ
authors.lastname: Boo
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Seung Uk
authors.initials: SU
authors.lastname: Jeong
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; C413685:entecavir; D006147:Guanine; D000410:Alanine Transaminase
keywords: Hepatitis B virus, chronic hepatitis B; acute exacerbation of hepatitis B, HBV genotype