Serologic and clinical outcomes of 1536 Alaska Natives chronically infected with hepatitis B virus

Ann Intern Med. 2001 Nov 6;135(9):759-68. doi: 10.7326/0003-4819-135-9-200111060-00006.


Background: Knowledge of the outcome of chronic hepatitis B virus (HBV) infection is limited.

Objective: To determine the incidence of and risk factors for adverse events (hepatocellular carcinoma and end-stage liver disease) and clearance of hepatitis B e antigen (HBeAg) and surface antigen (HBsAg) in carriers of HBV.

Design: Population-based cohort study of hepatitis B carriers who were observed for a median of 12.3 years as part of an active surveillance program to detect carriers with hepatocellular carcinoma.

Setting: 126 communities in Alaska.

Patients: 1536 Alaska Natives with chronic hepatitis B.

Measurements: Bivariate comparisons, multivariable models, and other statistical methods were used to examine the relationships of risk factors to outcomes and clearance of HBeAg and HBsAg.

Results: 1536 chronic HBV carriers were followed up for 19 430 person-years from their first HBsAg-positive test result. At the first serologic test, 641 were HBeAg positive and 893 were anti-HBe positive. Older carriers were more likely than younger carriers to clear HBeAg (P < 0.001). The observed probability of clearing HBeAg within 10 years of diagnosis was 72.5%. Clearance of HBsAg occurred in 106 (7%) of all carriers and was positively associated with older age and positive result on initial anti-HBe test. The incidence of adverse events was 2.3 per 1000 carrier-years, and the incidence of hepatocellular carcinoma was 1.9 per 1000 carrier-years (2.3 in men and 1.2 in women). Risk for hepatocellular carcinoma increased with age, among those of Yupik Eskimo ethnicity, and among carriers who reverted from anti-HBe to HBeAg.

Conclusion: In HBsAg-positive carriers, observed clearance of HBeAg was more than 70% during the first 10 years of follow-up.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alaska / epidemiology
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / etiology
  • Carrier State / ethnology
  • Carrier State / immunology*
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Hepatitis B e Antigens / blood*
  • Hepatitis B, Chronic / complications
  • Hepatitis B, Chronic / ethnology
  • Hepatitis B, Chronic / immunology*
  • Humans
  • Incidence
  • Infant
  • Inuits
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / etiology
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / etiology
  • Logistic Models
  • Male
  • Middle Aged
  • Population Surveillance


  • Hepatitis B e Antigens