The statement on the benign course after HBeAg-seroconversion has recently been challenged for Asian patients infected at birth or early childhood.4 However, two recent European studies have provided further evidence confirming the almost uniform non-progressive nature of the immune control/inactive carrier state phases.5,6 The report from Bortolotti5 describes 91 HBeAg-positive children who entered the long-term follow-up almost 30 years ago. Among 85 children without cirrhosis who seroconverted to anti-HBe, 80 became inactive carriers, 4 rapidly lost HBsAg, and 1 developed HBeAg-negative hepatitis. At the end of the follow-up, 68/80 were still inactive carriers, 9/80 had lost HBsAg, and 3/80 reactivated and developed HBeAg-negative hepatitis. In 4 children with cirrhosis and HBeAg seroclearance, 2/4 remained inactive carriers and 2/4 developed hepatocellular carcinoma.
The second study comprised 296 blood donors found to be HBsAg-positive between 1972-1977.Their course was compared to 157 HBsAg-negative blood donors matched for age, sex, and alcohol intake. At entry to the study, all HBsAg carriers were HBeAg-negative, anti-HBe-positive, and all but four had normal ALT levels. After 22-32 years of follow-up 32/296 patients and 14/157 controls had died. Hepatocellular carcinoma caused death in 2/296 and 1/157 subjects (0.6% in each group); non-liver related death occurred in 29/296 of cases and in 13/157 controls. Survival was independently predicted by older age, abnormal gamma-glutamyl transpeptidase levels, and the presence of medical comorbidity at baseline. Fifty-nin