Age-specific prognosis following spontaneous hepatitis B e antigen seroconversion in chronic hepatitis B

Area of Science:

• Hepatology
• Virology
• Oncology

Background:

• Hepatitis B e antigen (HBeAg) seroconversion is a key indicator of favorable prognosis in chronic hepatitis B virus (HBV) infection.
• The influence of the timing of HBeAg seroconversion on long-term patient outcomes remains incompletely understood.

Purpose of the Study:

• To investigate the impact of the age of HBeAg seroconversion on the long-term prognosis of patients with chronic hepatitis B.
• To compare the incidences of HBeAg-negative hepatitis, cirrhosis, and hepatocellular carcinoma (HCC) based on the age of HBeAg seroconversion.

Main Methods:

• Longitudinal follow-up of HBeAg-positive patients with biopsy-proven chronic hepatitis B.
• Regular monitoring of liver biochemistry, alpha-fetoprotein, and ultrasonography.
• Kaplan-Meier survival analysis and Poisson regression to compare outcomes across age groups at HBeAg seroconversion.

Main Results:

• Spontaneous HBeAg seroconversion was observed in 508 patients.
• Among 483 patients without cirrhosis or HCC at seroconversion, 15-year cumulative incidences of HBeAg-negative hepatitis, cirrhosis, and HCC increased significantly with age at seroconversion.
• Patients seroconverting after age 40 (Group C) showed substantially higher rates compared to those before age 30 (Group A): 66.7% vs. 31.2% for HBeAg-negative hepatitis, 42.9% vs. 3.7% for cirrhosis, and 7.7% vs. 2.1% for HCC.

Conclusions:

• HBeAg seroconversion before age 30 is associated with an excellent long-term prognosis in chronic hepatitis B patients.
• Delayed HBeAg seroconversion, particularly after age 40, is significantly linked to increased risks of subsequent HBeAg-negative hepatitis, cirrhosis, and HCC.