In order to evaluate the prognostic implications of the hepatitis B e system in patients with chronic persistent hepatitis (CPH), 53 consecutive patients were studied. Fourteen of 16 patients with HBsAg and HBeAg were followed from 12 to 120 months (mean, 38 months). Eleven of the 14 patients were persistently HBeAg positive and five of these developed chronic active hepatitis (CAH) or cirrhosis. A further nine patients were HBsAg positive but HBeAg negative at time of CPH diagnosis (mean follow-up, 47 months). One of these nine patients developed CAH during follow-up. The remaining 28 patients were all HBsAg negative, and only 2 of the 28 patients progressed to CAH or cirrhosis during the time of follow-up (mean, 43 months). It is concluded that the persistence of HBeAg in patients with CPH indicates a serious prognosis with a frequent transition to CAH or cirrhosis.
The diagnosis of chronic persistent hepatitis (CPH) is based on histological, biochemical, and clinical findings (1, 2). Generally, the prognosis of CPH is regarded as good (2-5). There are data, however, suggesting that histological changes compatible with CPH might not always identify a homogeneous disease entirety. Several authors (2, 4, 6) have found that in at least some of the patients, the disease progresses to chronic active hepatitis (CAH) or cirrhosis. On the basis of the findings in a single patient, it has been suggested that the presence of hepatitis B e antigen (HBeAg) in patients with CPH might indicate a poor prognosis (7).
In the present study, 53 patients with CPH were classified according to their serological status in order to evaluate the prognostic implications of the hepatitis B e system.