Recently, controversies have arisen about whether
hepatitis B e antigen (
HBeAg) seroconversion can result in regression of
fibrosis, thus improving the clinical outcome of Chinese patients with
chronic hepatitis B. In this study, we determined if spontaneous
HBeAg seroconversion is associated with regression of
fibrosis in Chinese
chronic hepatitis B patients. We evaluated the histology of liver samples from 128
HBeAg-positive treatment-naive Chinese patients who had undergone 2 liver biopsies over the years. Regression of
fibrosis was defined as a decrease in
fibrosis stage of at least 1 point. Sustained disease remission was defined as
HBeAg seroconversion and hepatitis B virus (HBV)
DNA < 10(4) copies/ml at follow-up liver biopsy. The mean duration (+/- standard error of the mean) between the initial and follow-up liver biopsies was 43.9 +/- 3.4 months. Regression of
fibrosis was higher in patients with sustained disease remission (5 of 13 [38.5%] versus 22 of 115 [19.1%], P < 0.00005), patients who were younger (20-29 years old) at initial liver biopsy (17 of 54 [31.5%] versus 10 of 74 [13.5%], P = 0.0004), and patients with genotype B (17 of 43 [39.5%] versus 10 of 85 [11.8%], P = 0.004). On multivariate analysis, sustained disease remission (relative risk [RR] 3.00, 95% confidence interval [95% CI] 1.29-7.01, P = 0.01) and being 20-29 years old at initial liver biopsy (RR 2.94, 95% CI 1.01-8.62, P = 0.04) were independently associated with regression of
fibrosis. The rate of
fibrosis progression was lower in patients with sustained disease remission than in those who remained
HBeAg positive (median 0
fibrosis units/year, range -2.00 to -0.70
fibrosis units/year, versus median 0.51
fibrosis units/year, range 0 to +2.03
fibrosis units/year, P = 0.02).
CONCLUSION: