Background: Identifying risk factors for the development of complications of chronic hepatitis B (CHB) is important for setting up treatment criteria. Aim: To determine risk factors for the development of complications in Asian CHB patients. Patients and methods: A total of 3233 Chinese CHB patients (mean follow up 46.8 months) were monitored for liver biochemistry, viral serology, hepatitis B virus (HBV) DNA levels, acute exacerbation, hepatitis B e antigen (HBeAg) serocon version, and development of cirrhotic complications and hepatocellular carcinoma . Results: Median age for HBeAg seroconversion and development of complications was 35 years and 57.2 years, respectively. Patients with alanine aminotransferas e (ALT) levels of 0.5-1 times the upper limit of normal (ULN) and 1-2 ×ULN ha d an increased risk for the development of complications compared with patients with ALT levels < 0.5 ×ULN (p< 0.0001 for both). HBeAg/antibody to hepatitis B e antigen status, and number of episodes, duration, and peak ALT levels of acute exacerbations were not associated with an increased risk of complications. In p atients with complications, 43.6%had HBV DNA levels less than 1.42×105 copies/ ml. Male sex, stigmata of chronic liver disease, old age, low albumin, and high a fetoprotein levels on presentation were independently associated with increase d cumulative risk of complications. Male sex, presence of hepatitis symptoms, ol d age, low albumin level, and presence of complications on presentation were ind ependently associated with shorter survival. Conclusion: Prolonged low level vir aemia causing insidious and continual liver damage, as reflected by ALT levels o f 0.5-2 ×ULN, is the most likely pathway for the development of complications in Asian CHB patients.
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