“…30 If HBeAg seroconversion occurs late in life (after the age of ϳ40 years), however, the prolonged immune response may still allow liver disease to progress. 31 Importantly, HBV reactivation may occur, either as a result of HBeAg seroreversion (ie, restored HBeAg positivity caused by reactivation of wildtype HBV), or, more frequently, as a result of the emergence of HBV mutants that no longer express HBeAg (ie, precore or basal core promoter [PC/BCP] mutants); the latter event, which results in HBeAg-negative CHB, is particularly common among patients from Asia or the Mediterranean, where the prevalence of PC/BCP mutants is high. 32 HBV reactivation can occur after years or decades of the inactive carrier state and represents, especially in the case of HBeAg-negative CHB, a late stage of the infection generally associated with advanced liver disease.…”