Seroconversion from HBe antigen to anti-HBe in chronic HBV infection
Among 116 patients with chronic hepatitis B virus infection and biopsy-proved chronic liver disease, the prevalence of hepatitis B e antigen (HB(e)Ag) in serum was higher in the cases with chronic active hepatitis without cirrhosis compared with those with chronic active hepatitis who had already progressed to cirrhosis. Accordingly, the opposite trend was noted in the prevalence of antibody to the hepatitis B e antigen (anti-HB(e)). The mean age of the HB(e)Ag-positive patients was significantly lower than that of the cases with anti-HB(e); in addition, the duration of the illness at the time of testing was apparently longer in the latter group, as assessed by the prevalence of an acute onset in the recent history. Fifty of the 116 patients were followed longitudinally over a period ranging from 2 to 7 yr; of the 29 cases initially HB(e)Ag-positive, 13 eventually lost the antigen, and 10 of them seroconverted to anti-HB(e). Seroconversion was always associated with a striking reduction in the activity of virus replication and prevailed in patients who progressed to cirrhosis. Transaminase levels improved in all the cases who seroconverted, independently of the histological evolution. These results suggest that in HB(s)Ag-positive chronic active hepatitis presence of HB(e)Ag in serum identifies an early, although prolonged, phase of active virus replication that is frequently followed by the disappearance of complete virus particles from serum and appearance of anti-HB(e). In these patients this event does not imply a good prognosis as it occurred mainly in those who developed cirrhosis. Immunosuppressive treatment appeared, in our experience, to delay seroconversion, but not to affect its incidence.
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