Natural history of hepatitis b e antigen to antibody seroconversion in patients with normal serum aminotransferase levels

HBeAg seroconversion as an important end point in the treatment of chronic hepatitis B

“…Similarly, in a prospective longitudinal study that assessed the natural history of HBeAg seroconversion and factors predictive of cirrhosis in 240 adult HBeAg-positive patients with normal ALT levels at entry, the persistence of HBeAg was associated with a higher likelihood of developing cirrhosis [9]. In this cohort, 85% of individuals underwent spontaneous HBeAg seroconversion between the age of 26 and 39 years, whereas only 10% underwent after the age of 40 years.…”

“…Clinical remission of liver disease and a sustained inactive state are observed in the majority of patients (67-85%) who underwent HBeAg seroconversion, particularly among those in whom HBeAg seroconversion occurred before the age of 30 years and who maintain low or PCRundetectable HBV-DNA levels [8,9,34]. Sustained disease remission after HBeAg seroconversion is associated with a regression of fibrosis upon liver biopsy.…”

“…However, active hepatitis may relapse because of the reactivation of wild-type HBV associated with the reappearance of serum HBeAg (HBeAg seroreversion), or HBV with precore or basal core promoter mutations that abolish or downregulate the translation of HBeAg (HBeAg-negative hepatitis) [8,9,37]. In cohort studies involving adult CHB patients from Taiwan who had undergone spontaneous HBeAg seroconversion, the estimated annual incidence of hepatitis relapse was 2.2-3.3% [8,9].…”

“…In cohort studies involving adult CHB patients from Taiwan who had undergone spontaneous HBeAg seroconversion, the estimated annual incidence of hepatitis relapse was 2.2-3.3% [8,9]. In one of these studies involving 283 patients with CHB who were followed for a median period of 8.6 years after HBeAg seroconversion, 4.2% had HBeAg reversion and 24% developed HBeAg-negative hepatitis with detectable HBV-DNA; most patients relapsed during the first 10 years after HBeAg seroconversion.…”

“…Seropositivity for hepatitis B e antigen (HBeAg), a surrogate marker of active viral replication, has been shown to be a significant risk factor for the development of cirrhosis and HCC [4][5][6][7]. Spontaneous loss of HBeAg and development of antibodies to HBeAg (anti-HBe), referred to as HBeAg seroconversion, are associated with low HBV-DNA levels and clinical remission of liver disease in the majority of patients [8][9][10][11]. Earlier HBeAg seroconversion, or a shorter HBeAg-positive phase, is associated with a higher chance of sustained remission, lower rate of HBeAg reversion, and slower progression of liver disease and even increased hepatitis B surface antigen (HBsAg) seroclearance [10][11][12][13][14].…”