Spontaneous relapse of hepatitis in inactive HBsAg carriers

Background/aims The issue of spontaneous relapse of hepatitis in anti-HBe positive asymptomatic HBsAg carriers was rarely reported before and deserves further exploration. Methods A total of 1241 anti-HBe positive asymptomatic adult HBsAg carriers were prospectively followed up. Of these, 661 (53%) were males, and the mean (+/- SD) age was 35.6 +/- 9.1 years. Relapse of hepatitis was defined as elevation of ALT more than twice the upper limit of normal accompanied by detectable serum HBV DNA by hybridization assays. Results During a mean follow up of 12.3 years, hepatitis relapsed in 211 patients with an annual rate of 1.46%. The cumulative probabilities of hepatitis relapse were 10.2%, 17.4%, 19.3%, 20.2%, and 20.2%, respectively, after 5, 10, 15, 20, and 25 years of follow up. Multivariate analyses showed that the probability of hepatitis relapse correlated significantly with male sex (P < 0.0001) and age at entry (P = 0.007). The cumulative probability of hepatitis relapse after 20 years was 26.9% for males and only 12.5% for females, and was 13.1% for those of age < 30 years at entry but increased to 29.4% for those of age 40-49 years at entry. Conclusion Hepatitis relapsed in about 20% of asymptomatic HBsAg carries during 25 years of follow up. Relapse of hepatitis occurred more frequently during earlier years of follow up. Males were more likely to have relapse of hepatitis than females. In addition, relapse of hepatitis was significantly less frequent in patients who were younger than 30 years at study entry, possibly implicating more favorable outcome of earlier HBeAg seroconversion.