Spontaneous reactivation of hepatitis B virus replication in HBsAg carriers who seroconverted from HBeAg to Anti-HBe.

Twenty one patients with chronic liver disease (CLD), type B, who were persistently positive for anti-HBe after disappearance of HBeAg, were studied for serial measurement of HBV DNA and DNA-Pin serum in relation to the elevation of alanine aminotransferase (ALT). Patients were selected and allocated to two groups on the basis of having been seen for at least 3 years and having been found to have either fluctuating, or normal ALT levels during the course of their disease activity. Nine patients have had fluctuating or sustainingly abnormal ALT levels and the remaining 12 have had sustainingly normal ALT levels for at least 3 years follow-up period after anti-HBe seroconversion. In 2 patients, ALT levels were persistently elevated with positive HBV DNA and DNA-P in serum, and in 6, ALT levels were fluctuated between normal range and more than six times the normal, in whom serum HBV DNA and DNA-P became also positive with ALT elevation. In one patient, serum HBV DNA and DNA-P became transiently positive with ALT elevation. On the contrary, 12 patients with normal ALT levels were persistently negative for both HBV DNA and DNA-Pin serum. Therefore, we may conclude that in patients with anti-HBe positive CLD, type B, ALT elevation is associated with reactivation of HBV replication.