Spontaneous seroconversion in hepatitis B e antigen-positive chronic hepatitis B: implications for interferon therapy

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Chronic hepatitis B virus (HBV) infection affects millions globally.
• Hepatitis B e antigen (HBeAg) seroconversion marks a milestone in HBV infection, indicating reduced viral replication and infectivity.
• Interferon-alpha therapy has been a standard treatment for chronic HBV, aiming to induce seroconversion.

Purpose of the Study:

• To compare spontaneous HBeAg seroconversion rates in chronic HBV carriers with rates during interferon-alpha therapy.
• To evaluate the influence of age on spontaneous seroconversion rates.

Main Methods:

• A cohort of 454 Asian-American HBeAg-positive HBV carriers was followed for 1-10 years.
• HBeAg status was assessed every 6 months.
• Seroconversion rates were analyzed based on age groups (5-19, 20-34, 35-50 years) and baseline alanine aminotransferase (ALT) levels.

Main Results:

• Spontaneous seroconversion occurred in 15% of children, 23% of adults aged 20-34, and 17% of adults aged 35-50.
• These spontaneous rates were comparable to or higher than reported rates during interferon-alpha treatment (30% in children, 33% in adults).
• Higher spontaneous seroconversion rates were observed in patients with ALT levels >= 50 IU/mL.

Conclusions:

• Spontaneous HBeAg seroconversion is a significant event in chronic HBV infection, particularly in younger adults.
• The high rate of spontaneous seroconversion necessitates a re-evaluation of the routine use of interferon-alpha therapy in HBeAg-positive HBV carriers.
• Treatment decisions should carefully weigh the potential benefits of interferon-alpha against the likelihood of spontaneous viral clearance.