This retrospective study examined 220 Chinese chronic hepatitis B virus carriers over 5 years. After initial liver biopsy, liver function tests and serological analysis, patients underwent further tests of liver function and hepatitis B seromarkers at 6-month intervals. Second and third liver biopsies were performed in 56 and 23 patients, respectively. Liver pathology was classified according to inflammatory activity (G(0) - G(4)) and degree of fibrosis (S(0) - S(4)). A significantly greater proportion of hepatitis B e antigen antibody-positive patients had a more severe level of inflammation and fibrosis than patients who were hepatitis B e antigen (HBeAg)-positive. Abnormal inflammation (≥ G(2)) occurred in 122 (55.5%) patients. Hepatitis B reactivation occurred in 35 (15.9%) patients: 33 had obvious liver inflammation at the initial biopsy (≥ G(2)) and only two had a low level of liver inflammation (G(0) - G(1)). The hepatitis B reactivation rate was significantly related to age but not to gender. Hepatitis B surface antigen clearance was 1.55% per year and HBeAg seroconversion was 5.36% per year. In conclusion, hepatitis B reactivation was closely correlated with age and the level of liver inflammation.