Determinants for hepatitis B e antigen clearance in chronic type B hepatitis

ABSTRACT— A 6‐year (mean 24.5 months) longitudinal study has been undertaken in 237 HBeAg‐positive patients with clinicopathologically verified chronic hepatitis. HBeAg clearance occurred in 74 patients at a rate of 16% per year, and a cumulative probability of 67% at the end of a 5‐year follow‐up. HBeAg clearance was preceded by a temporary “exacerbation” with SGPT> 300 IU/L in 62% of the patients. On the other hand, irrespective of the level of SGPT elevation, only 23% of such exacerbations were followed by HBeAg clearance. Further analysis indicates that alphafetoprotein >100 ng/ml, frequently associated with bridging hepatic necrosis, during “exacerbation” predicts HBeAg clearance. In addition, patients with chronic lobular hepatitis and chronic active hepatitis have a higher annual HBeAg clearance rate than patients with chronic persistent hepatitis and nonspecific histologic changes (>15% vs <8%, P<0.03). Short‐term immunosuppressive treatment did not delay HBeAg seroconversion. Male patients had a higher annual HBeAg clearance rate than female patients (18.2% vs 8.7%, P<0.05). It was concluded that, in addition to the time factor, the nature of chronic hepatitis, the extent of hepatic damage during “exacerbation”, and the sex of the patients are important determinants for HBeAg clearance.