Serological and virological response in patients with hepatitis B virus genotype E treated with entecavir or tenofovir: a prospective study


European clinical practice guidelines (EASL) on chronic hepatitis B (CHB) recently recognized the importance of migration flows in the changing hepatitis B virus (HBV) epidemiology in low-endemic European countries. The role of different genotypes in nucleos(t)ide analogue (NA) treatment is still unknown. In the case of genotype E, which is mainly circulating in West Africa, a quantitative decrease in the level of HBsAg (qHBsAg) during treatment with entecavir (ETV) predicts a longer time to HBsAg loss when compared to genotypes A and D. We prospectively evaluated qHBsAg decline in HBeAg-negative CHB patients infected with HBV genotype E who were treated with tenofovir 245 mg (TDF) or ETV 0.5 mg from 2008 to 2014. Sixty-five West African patients (58; 89.2% males) were enrolled. The median age was 29 years, and the most prevalent route of transmission was familial (25; 38.5%). Median liver stiffness was 7.4 kPa, HBV-DNA was 4.7 Log IU/ml, and qHBsAg was 3.4 Log UI/ml. According to clinical evaluation, 40 patients (61.5%) started ETV treatment, whereas 25 patients (38.5%) started TDF treatment. The decline of qHBsAg in ETV patients was significantly lower than in TDF patients after 5 years of treatment (0.31 vs. 0.68 LogIU/mL, p < 0.001). At the same time points, a significantly higher virological non-response rate was observed in ETV patients (p < 0.001). Despite the partial and non-response rates observed in the ETV group, no mutations associated with drug resistance were detected in these subjects. In genotype E infections, ETV treatment results in a significantly lower decline in qHBsAg and higher rates of virological non-response after 5 years. TDF could represent the optimal choice.

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Hepatitis B virus


Nucleos(t)ide analogues


Chronic hepatitis B


Inactive carrier


Pegylated interferon


Hepatitis B surface antigen


Quantitative HBsAg


Alanine aminotransferase


Hepatitis e antigen


Sustained response


Upper normal level


Inter-quartile range


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Correspondence to Lucio Boglione.

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This study was approved by the local ethics committee as “HBV-Analogues Study” (Prot. N°002360; 26/1/2015) and all included subjects provided written informed consent.

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Boglione, L., De Benedetto, I., Lupia, T. et al. Serological and virological response in patients with hepatitis B virus genotype E treated with entecavir or tenofovir: a prospective study. Arch Virol 166, 1125–1131 (2021).

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