Hepatitis B Surface Antigen Loss and Sustained Viral Suppression in Asian Chronic Hepatitis B Patients: A Community-Based Real World Study. Journal of viral hepatitis Wong, R. J., Nguyen, M. T., Trinh, H. N., Chan, C., Huynh, A., Ly, M. T., Nguyen, H. A., Nguyen, K. K., Torres, S., Yang, J., Liu, B., Garcia, R. T., Bhuket, T., Baden, R., Levitt, B., da Silveira, E., Gish, R. G. 2017

Abstract

Community-based real-world outcomes on effectiveness of antiviral therapies for chronic hepatitis B virus (CHB) in Asians are limited. Whether hepatitis B surface antigen (HBsAg) loss correlates with undetectable virus and alanine aminotransferase (ALT) normalization on treatment or what predicts risk of seroreversion or detectable virus after stopping therapy is unclear. We aim to evaluate rates and predictors of HBsAg loss, seroconversion, ALT normalization and undetectable HBV DNA, including HBsAg seroreversion or re-emergence of HBV DNA among Asian CHB patients. We retrospectively evaluated 1,072 CHB adults on antiviral therapy at two community gastroenterology clinics from 1997-2015. Rates of HBsAg loss, ALT normalization, achieving undetectable HBV DNA, and developing surface antibody (anti-HBs) were stratified by HBeAg status. Following HBsAg loss, HBsAg seroreversion or re-emergence of detectable HBV DNA were analyzed. With median treatment of 76.7 months, the overall rate of HBsAg loss was 4.58%, with similar HBsAg loss rates between HBeAg-positive and HBeAg-negative patients (4.44% vs. 4.71%, p=0.85) in a predominantly Asian population (98.1%). Among HBsAg loss patients, 33.3% developed anti-HBs, 95.8% achieved undetectable virus, and 66.0% normalized ALT. No significant baseline or on-treatment predictors of HBsAg loss were observed. While 6 patients who achieved HBsAg loss had seroreversion with re-emergence of HBsAg positivity, viral load remained undetectable, demonstrating the sustainability of viral suppression. Among a large community-based real-world cohort of Asian CHB patients treated with antiviral therapy, rate of HBsAg loss was 4.58%. Despite only 33.3% of HBsAg loss patients achieving anti-HBs, nearly all patients achieved sustained undetectable virus. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/jvh.12736

View details for PubMedID 28581644