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Gastroenterology. 2007 Nov;133(5):1458-65. Epub 2007 Aug 21.

Predictive factors for reactivation of hepatitis B following hepatitis B e antigen seroconversion in chronic hepatitis B.

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Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.



Predictors of reactivation of hepatitis B following hepatitis B e antigen (HBeAg) seroconversion in chronic hepatitis B have rarely been reported before and deserve further study.


A total of 133 HBeAg-positive asymptomatic carriers who have undergone HBeAg seroconversion were studied. Reactivation of hepatitis B was defined as elevation of alanine aminotransferase >2 x upper normal limit accompanied by serum hepatitis B virus DNA detectable by hybridization assays.


The samples consisted of 75 men and 58 women, and the mean age at entry was 28.2 +/- 6.9 years. One hundred eight subjects had genotype B, and 25 had genotype C. The maximal alanine aminotransferase levels during the HBeAg-positive phase were <2, 2-5, and >5 x upper normal limit in 49, 40, and 44 subjects, respectively. HBeAg seroconversion occurred after a mean follow-up of 4.6 +/- 3.7 years. During a mean follow-up of 5.8 +/- 4.6 years following HBeAg seroconversion, reactivation of hepatitis B occurred in 26 patients at 3.3% per year. Multivariate analyses demonstrated that reactivation of hepatitis B correlated significantly with genotype C (P = .003), male sex (P = .03), alanine aminotransferase levels >5 x upper normal limit during the HBeAg-positive phase (P = .02), and age at HBeAg seroconversion >/=40 years (P = .002).


At baseline, genotype C and male sex are independent factors predictive of reactivation of hepatitis B. Additionally, the likelihood of reactivation of hepatitis B is increased if more rigorous immune-mediated hepatocytolysis or more prolonged immune clearance phase is necessary to eliminate the virus.

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