Hepatitis B surface antigen loss and sustained viral suppression in Asian chronic hepatitis B patients: A community‐based real‐world study

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 1072 CHB adults on antiviral therapy at two community gastroenterology clinics from 1997 to 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 was analysed. 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=.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 six 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.

Predictors of sustained functional cure in hepatitis B envelope antigen‐negative patients achieving hepatitis B surface antigen seroclearance with interferon‐alpha–based therapy

“…In our study, 176 HBeAg‐negative CHB patients achieved functional cure using an IFN‐based therapy, 52.27% achieved seroconversion along with HBsAg clearance, and 27.84% obtained seroconversion during consolidation therapy. The seroconversion rate by IFN‐based therapy in this study was higher than that achieved by NA therapy in the study by Wong et al . The higher rate of seroconversion by IFN‐based therapy compared with NA therapy might be associated with the capacity of IFN to stimulate immune cell function.…”

“…therapy in this study was higher than that achieved by NA therapy in the study by Wong et al30 The higher rate of seroconversion by IFN-based therapy compared with NA therapy might be associated with the capacity of IFN to stimulate immune cell function.…”

“…29 In NA treatment-induced HBsAg loss, only 33.33% of cases were accompanied by seroconversion. 30 It was suggested in another study that patients require 12 months of consolidation treatment following HBsAg loss induced by NA In the present study, only 17.76% of patients with baseline HBsAb negativity had HBsAb become positive during follow-up.…”

“…Hepatitis B surface antigen seroconversion indicates the immunological cure from chronic HBV infection and is associated with a strong immunity against HBV . In NA treatment‐induced HBsAg loss, only 33.33% of cases were accompanied by seroconversion . It was suggested in another study that patients require 12 months of consolidation treatment following HBsAg loss induced by NA treatment …”

Beneficial Effects of Bushen Formula Combined with Enticavir on Chronic Hepatitis B Patients with Suboptimal Response to Enticavir by Regulating B-Cell Differentiation

“…Currently, there are limited data on how to improve the efficacy of anti-virus therapy for this group of patients. Among a large community-based real-world cohort of Asian CHB patients treated with antiviral therapy, rate of HBsAg loss was 4.58% [30]. In our study, 32 CHB patients with suboptimal response to ETV in T-Group were treated with ETV combined with BSF for 12 months, and after treatment, the rate of HBsAg reduction>0.5 log 10 IU/ml, the rate of HBsAg reduction>1.0 log 10 IU/ml and the rate of HBeAg clearance in T-Group were all higher than those in C-group, but no significant intergroup differences were observed because of the limited number of patients.…”