Natural history of chronic hepatitis B virus infection

Abstract

In chronic hepatitis B virus (HBV) infection acquired during adulthood, which is the type mostly seen in the Caucasian population, there is biochemical and histologic regression after HBeAg seroconversion, and the risk of death from hepatitis B-related causes is low. In chronic HBV infection acquired during birth or early childhood, which is the type most commonly seen in the Asian population, there is a prolonged phase of immunotolerance. The immune clearance phase is characterized by multiple acute exacerbations preceeded by elevations in serum HBV DNA levels, HBeAg concentration and HBeAg/anti-HBe immune complexes. Of these patients, 2.4% may develop hepatic decompensation during the stage of HBeAg seroconversion. The development of cirrhosis occurs more frequently in patients with episodes of decompensation and with repeated severe acute exacerbations. However progression to cirrhosis can be relatively silent and can occur even in children. After HBeAg seroconversion, precore and core promotor mutations occur frequently in the Asian population. However, there is little correlation between the occurrence of these mutations and alanine aminotransferase elevation in patients who are positive for anti-HBe. Although cirrhosis develops during the process of HBeAg seroconversion, 68% of the complications of cirrhosis and of hepatocellular carcinoma occur after HBeAg seroconversion. These complications may still occur even after HBsAg seroclearance.

Detection of Intrahepatic Hepatitis B Virus DNA and Correlation with Hepatic Necroinflammation and Fibrosis

“…This further confirms that, at least in Chinese patients, cirrhosis or complications of cirrhosis can still occur with HBV DNA levels below 10 5 copies/ml (6,20). Chinese patients with chronic hepatitis B infection can develop complications of cirrhosis and/or hepatocellular carcinoma after HBeAg seroconversion and even after they lose HBsAg (19). Quantitative measurement of intrahepatic HBV DNA correlates with the degree of fibrosis and may give some insight and prognostic guide for Asian patients.…”

Genotype C hepatitis B virus infection is associated with a higher risk of reactivation of hepatitis B and progression to cirrhosis than genotype B: A longitudinal study of hepatitis B e antigen-positive patients with normal aminotransferase levels at baseline

“…Moreover, the most significant independent factor for prediction of cirrhosis is reactivation of hepatitis B, which is associated with a 13-to 14-fold increased risk of cirrhosis (Table 3). The majority (12/15) of our patients was diagnosed to have cirrhosis after HBeAg seroconversion, suggesting that HBeAg seroconversion does not necessarily implicate favorable outcome [33]. Reactivation of hepatitis B after HBeAg seroconversion may contribute significantly to progression to cirrhosis (Fig.…”

Benefit of Lamivudine Therapy and Factors Associated with Clinical Outcome in Spontaneous Severe Acute Exacerbation of Chronic Hepatitis B Virus Infection

“…It is associated with the major modes of transmission and infectionacquired age, which influence clinical course of the infec- tion [1,18]. Additionally, there are marked differences in standards of medical practice, living environment, economic climate, and public education level among countries.…”