HBsAg seroclearance after nucleoside analogue therapy in patients with chronic hepatitis B: clinical outcomes and durability

Abstract

HBsAg seroclearance achieved after NUC treatment was associated with favourable clinical outcomes and was durable in most cases during long-term follow-up.

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

“…Spontaneous HBsAg seroreversion with reactivation of the inflammatory liver process after HBsAg loss is rare and may occur in patients with a significant impairment of their immune function. [47][48][49][50][51][52] The main advantage of HBsAg loss is that it allows a safe discontinuation of antiviral therapy. As chronic HBV infection cannot be completely eradicated due to the persistence of cccDNA and integrated HBV DNA, 1 The indications for treatment are generally the same for both HBeAg-positive and HBeAg-negative CHB (Fig.…”

Factors associated with the decrease in hepatitis B surface antigen titers following interferon therapy in patients with chronic hepatitis B: Is interferon and adefovir combination therapy effective?

“…Although several kinds of NAs are available, including lamivudine, telbivudine, entecavir, emtricitabine, adefovir dipivoxil (ADV), and tenofovir (8), patients cannot stop treatment because covalently closed circular (ccc)DNA is stably incorporated into the nucleus of hepatocytes, even after treatment with an NA (6,8). Currently, however, the efficacy of IFN in combination with an NA is not well established and some controversial findings have been published (9,10).…”

“…In recent years, serum HBsAg titer has been established as a useful marker for monitoring the response to antiviral therapy and is associated with the severity of fibrosis among HBeAg-positive CHB patients (4,5). Moreover, achieving HBsAg seroclearance is an ultimate aim of antiviral therapy and is related to favorable clinical outcomes of CHB (6).…”

The decrease of HBsAg during nucleos(t)ide analogues (NUC) therapy in Bulgarian patients

“…Reduction in HBsAg level of >1 log10 by the 3rd or the 6th month, as well as baseline ALT levels more than five times of the upper limit of normal levels, were identified as important strong predictors of HBsAg clearance. [28,30] HBsAg loss may be also influenced by HBV genotype. It has been reported that, the clearance of HBsAg by NUC is higher in genotype A than in genotype non-A [11] and that HBsAg loss is very rare in Asian patients with genotype B or C. [16,26,31] Only one of our HBeAg-positive patients achieved a marked HBsAg drop to 100 IU/mL.…”