Clin Mol Hepatol.  2014 Dec;20(4):355-360. 10.3350/cmh.2014.20.4.355.

Is it necessary to delay antiviral therapy for 3-6 months to anticipate HBeAg seroconversion in patients with HBeAg-positive chronic hepatitis B in endemic areas of HBV genotype C?

• Song BC
• Cho YK
• Jwa H
• Choi EK
• Kim HU
• Song HJ
• Na SY
• Boo SJ
• Jeong SU

• KMID: 2070253
• DOI: http://doi.org/10.3350/cmh.2014.20.4.355

Abstract

BACKGROUND/AIMS
Spontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection.
METHODS
Ninety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels.
RESULTS
Only one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA > or =5.1x107 IU/mL and ALT > or =5xULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure.
CONCLUSIONS
Spontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection.

Keyword

Hepatitis B virus, chronic hepatitis B; acute exacerbation of hepatitis B, HBV genotype

MeSH Terms

Adult
Alanine Transaminase/blood
Antiviral Agents/*therapeutic use
DNA, Viral/blood
Female
Follow-Up Studies
Genotype
Guanine/analogs & derivatives/therapeutic use
Hepatitis B e Antigens/*blood
Hepatitis B virus/*genetics
Hepatitis B, Chronic/*drug therapy
Humans
Male
Middle Aged
Prospective Studies
Risk Factors
Alanine Transaminase
Antiviral Agents
DNA, Viral
Hepatitis B e Antigens
Guanine