Prevalence and clinical significance of HBeAg-positive chronic hepatitis B patients with and without anti-HBe antibody

The clinical significance of the coexistence of hepatitis B e antigen (HBeAg) and antibodies against HBeAg (anti-HBe) in patients with chronic hepatitis B (CHB) remains unclear. This study investigated the clinical features and phase transition of patients with coexisting HBeAg/anti-HBe. A total of 840 treatment-naïve HBeAg-positive CHB patients from two medical centres were included. Cox regression analysis was used to analyze factors associated with HBeAg clearance and seroconversion. Eighty-six patients (10.2%) had coexisting HBeAg/anti-HBe. Patients with anti-HBe were older (39.0 vs. 34.0 years, <i>p</i>=0.016) and had a higher FIB-4 values (1.5 vs. 1.0, <i>p</i>&lt;0.001) than those without anti-HBe. The proportions of HBeAg clearance (41.9% vs. 16.2%, <i>p</i>&lt;0.001) and HBeAg seroconversion (37.2% vs. 11.4%, <i>p</i>&lt;0.001) were significantly higher in patients with coexisting HBeAg/anti-HBe than in those without anti-HBe during the follow-up period. Surprisingly, 39.5% of patients with anti-HBe transitioned to HBeAg-positive and anti-HBe-negative status. A total of 4.7% of patients with HBeAg and anti-HBe coexistence transitioned to HBeAg-negative and anti-HBe-negative status. Patients with anti-HBe had higher cumulative HBeAg clearance and seroconversion rates than those without anti-HBe (<i>p</i>&lt;0.001). HBeAg/anti-HBe coexistence was associated with higher HBeAg clearance (HR 2.960, 95%CI 1.828–4.791, <i>p</i>&lt;0.001) and HBeAg seroconversion (HR 4.018, 95% CI 2.372–6.805, <i>p</i>&lt;0.001). Patients with coexisting HBeAg and anti-HBe had a higher likelihood of HBeAg clearance and seroconversion. Close follow-up is needed to monitor the phase transitions in patients with coexistence of HBeAg and anti-HBe patients.