Long‐term follow‐up of 60 patients with chronic hepatitis B. I. Seroconversion in the hepatitis B e‐system, frequency of delta infection and histological outcome

Abstract

ABSTRACT— Sixty patients with liver biopsy documented chronic hepatitis B attending Roslagstull Hospital for Infectious Diseases, Stockholm, Sweden, were followed during a mean period of 53 months (range 7–133 months) in order to evaluate the frequency of delta infection and HBeAg seroconversion as well as the histological outcome as assessed by liver biopsy. Spontaneous HBeAg clearance and development of anti‐HBe occurred among 17 of 36 initially HBeAg positive patients (47%), corresponding to an annual seroconversion rate of 11%. Biochemical improvement was noted in 7/17 patients (41%) after seroconversion as against in 2/19 patients (10.5%) with HBeAg persistence. Superinfection with the delta agent was seen to be associated with severe liver injury among drug addicts and immigrants with chronic hepatitis B. In the absence of a delta infection, progressive liver disease seemed to be associated with persistence of HBeAg. Although none of the homosexual men studied were delta superinfected, 71% developed chronic active hepatitis (CAH) with or without cirrhosis (CI).

HBeAg‐positive hepatitis delta: virological patterns and clinical long‐term outcome

“…A potential virological mechanism, how HDV can suppress HBV, has recently been suggested, as HDV proteins p24 and p27 may repress HBV enhancers . Of note, even in the context of suppressed HBV replication, two‐third of the patients remained HBeAg‐positive during further long‐term follow‐up leading to an HBeAg loss of about 5%/year which would be slightly lower than in HBV‐monoinfected cohorts .…”