The good and evil of flare: flares in hepatitis B virus chronic hepatitis

Treatment of HBeAg-positive chronic hepatitis B with pegylated interferon achieves HBeAg seroconversion in about 30% of patients and retreatment of nonresponders is followed by a low rate of sustained response. Alanine aminotransferase flares occurring after the introduction of interferon are considered a positive predictor of response. Here we described a young patient with active chronic hepatitis B who underwent four different treatment courses developing lamivudine resistance and showing three elevated flares of different origin and with diverse outcome. We discuss the meaning of each flare and their role in treatment response or virus reactivation.