Delayed e antigen seroconversion to anti-Hbe, such as e antigen positivity after the age of 40 years, has been associated with poor prognosis.23 Despite relatively low liver mortality in people younger than 40 years, the development of cirrhosis can precede CLD death by many years.30 Thus, a carrier who dies at 40 years of age may have already developed cirrhosis in their fourth decade of life. This evidence concerns the gene HBE1 and congenital secretory chloride diarrhea 1.