Durability of Hepatitis B e Antigen Seroconversion in Chronic Hepatitis B Patients Treated with Entecavir or Tenofovir
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Loss of HBeAg and development of anti-HBe (seroconversion) is seen as a milestone and endpoint in the treatment of HBeAg-positive patients with chronic hepatitis B (CHB). Among patients treated with nucleos(t)ide analogs (NA), recurrent viremia is common after discontinuation of therapy. Entecavir (ETV) and tenofovir (TDF) are highly potent NA. The durability of virological response and HBeAg seroconversion in patients treated with these agents is not well studied.
We retrospectively studied the outcomes of 54 HBeAg-positive CHB patients who were treated with either ETV (n = 30) or TDF (23) or both (n = 1) that achieved virological response and underwent seroconversion and consolidation therapy before cessation of treatment.
Only 4 (7 %) patients had sustained virological, serological, and biochemical remission. Thirteen patients (24 %) continued to have HBV DNA levels below 2000 IU/mL and normal alanine aminotransferase activity (ALT). Thirty-seven patients (69 %) developed HBV DNA >2000 IU/mL, with 20 having elevated ALT. Among these 37 patients, 23 (62 %) remained HBeAg negative/anti-HBe positive, 12 (32 %) became HBeAg positive, and 2 (5 %) were HBeAg and anti-HBe negative. Duration of consolidation therapy did not correlate with low versus high level of virological relapse.
Durability of HBeAg seroconversion associated with ETV or TDF was not superior to that reported in patients treated with less potent NA. Our results, aggregated with others, suggest HBeAg seroconversion should not be considered as a treatment endpoint for most HBeAg-positive patients treated with NA. Future updates of treatment guidelines should reconsider HBeAg seroconversion as an endpoint to therapy.
KeywordsRemission Relapse Seroreversion
We thank Dr. Dat Nghiem for reviewing this manuscript and for his thoughtful comments and suggestions. Authors received the grant support from Gilead Sciences and Daughters of Charity Foundation.
Compliance with Ethical Standards
Conflict of interest
Tse-Ling Fong and Myron J Tong: Gilead Sciences; Speaker Bureau, Advisory Board, Research Funding. BMS; Speaker Bureau, Advisory Board, Research Funding. Andy Tien, Kahee J. Jo, Wafa Mohammed, Andrew Velasco, Vinh-Huy LeDuc, Nickolas Nguyen, Yong-Won Cho and Stewart L. Cooper: No industry relationships or conflicts of interest. Danny Chu, Eddie Cheung, Edward A. Mena, Quang-Quoc Phan, Andy Yu, Steven-Bui Han, Ho S. Bae: Gilead Sciences; Speaker Bureau, Advisory Board. BMS; Speaker Bureau, Advisory Board. Mimi Chang: Gilead Sciences; Speaker Bureau. BMS; Speaker Bureau.
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