HBeAg seroconversion as an important end point in the treatment of chronic hepatitis B
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During the natural history of chronic hepatitis B virus (HBV) infection, the loss of serum hepatitis B e antigen (HBeAg) and the development of anti-HBe antibodies (HBeAg seroconversion) mark a transition from the immune-active phase of disease to the inactive carrier state. This review examines the evidence from natural history and cohort studies on the relationship between HBeAg seroconversion and disease progression. The role of HBeAg seroconversion as an important milestone in the management of HBeAg-positive patients with chronic hepatitis B (CHB), as well as the advantages and disadvantages of administering a finite course of therapy for HBeAg-positive CHB, is also discussed. The evidence from natural history and cohort studies indicates that spontaneous or treatment-induced HBeAg seroconversion is associated with lower rates of disease progression to cirrhosis and hepatocellular carcinoma, a potential of hepatitis B surface antigen seroconversion, and improved survival rates. Updated guidelines developed by major liver associations recommend stopping oral therapy for HBeAg-positive patients who achieve sustained HBeAg seroconversion with polymerase chain reaction-undetectable HBV-DNA on two separate occasions for 6 or more months apart, taking into consideration the individual’s clinical and virologic response to therapy, as well as the severity of liver disease. Thus, early induction of HBeAg seroconversion with interferon-based therapy or oral nucleos(t)ide analogues has important clinical and socioeconomic implications for the management of CHB.
KeywordsHBeAg seroconversion Hepatitis B virus Chronic hepatitis B Nucleoside analogue Interferon alfa
The author thanks Kathleen Covino, PhD, for her editorial contributions and assistance in the preparation of the manuscript and Ms Su-Chiung Chu for her excellent secretarial assistance.
Conflict of interest statement
The author has been involved in clinical trials and served as a global advisory board member of Roche, BMS, GSK, Novartis, and Gilead Sciences.
- 1.World Health Organization. Hepatitis B fact sheets. Available from: http://www.who.int/mediacentre/factsheets/fs204/en. Accessed 27 Oct 2008
- 53.Wang Y, Hou JL, Chutaputti A. Sustained durability of HBeAg seroconversion in patients with chronic hepatitis B treated with telbivudine or lamivudine. Hepatol Int 2008;2:S165. Abstract no. PP-363Google Scholar
- 58.Liaw YF. Antiviral therapies of chronic hepatitis B: opportunities and challenges in Asia. J Hepatol 2009. doi: 10.1016/j.jhep.2009.04.003
- 59.Taiwan Bureau of National Health Insurance. Medical care of liver disease [in Chinese]. [November 11]. Available from: http://www.nhi.gov.tw/06inquire/query8_detail.asp?News_ID=380. Accessed 6 Feb 2009
- 67.Yoon SK, Jang JW, Kim CW, Bae SH, Choi JY, Choi SW, et al. Long-term results of lamivudine monotherapy in Korean patients with HBeAg-positive chronic hepatitis B: response and relapse rates, and factors related to durability of HBeAg seroconversion. Intervirology 2005;48:341–349PubMedCrossRefGoogle Scholar