Relevance of quantitative HBsAg (qHBsAg) during long-term treatment of chronic hepatitis B with nucleos(t)ide analogues (NUCs)

Jaroszewicz, Jerzy; Ho, H.P.; Deterding, Katja; Markova, AA; Wursthorn, Karsten; Tillmann, HL; Schulz, Sandra; Bock, T.; Manns, MP; Wedemeyer, Heiner; Cornberg, Markus

doi:10.1055/s-0030-1269706

Cited by 1 publication

(4 citation statements)

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“…In contrast to interferon therapy [53,55,60,61], early HBsAg kinetics alone during NA therapy may not reliably predict later HBsAg loss. In this German cohort, HBsAg decline of more than 0.5 log in the 2 years after virological response (defined as HBV DNA <100 IU/ml) was associated with later HBsAg loss [78]. However, patients who received no treatment also demonstrated similar HBsAg kinetics during the natural course of HBV infection in this study.…”

Section: Hbeag-positive Patientsmentioning

confidence: 44%

“…The end of treatment HBsAg response could also predict sustained viral suppression and HBsAg loss up to 5 years after stopping lamivudine. However, in another German study with predominantly HBeAg-negative patients (67%) on NA therapy, early on-treatment decline did not necessarily predict HBsAg loss [78]. Some patients with early HBsAg decline during NA therapy might have just changed the phase of HBV infection (i.e.…”

Section: Hbeag-positive Patientsmentioning

confidence: 95%

“…This may reflect the remaining cccDNA in the infected hepatocytes in patients with long-term established chronic HBV infection. This is different to the situation during acute HBV infection where HBV DNA and HBsAg decline in parallel [78]. Borgniet et al analyzed HBsAg kinetics in 16 patients who cleared HBsAg during antiviral therapy.…”

Section: Current Evidencementioning

confidence: 95%

“…Thus, most patients treated with NA will require life-long maintenance therapy. Taking all currently available data into account, HBsAg loss during NA therapy may be limited to patients with more active immune responses also supported by data showing than NA induced HBsAg loss is associated with higher baseline ALT [76,78].…”

Section: Hbeag-positive Patientsmentioning

confidence: 99%

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Hepatitis B surface antigen quantification: Why and how to use it in 2011 – A core group report

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Quantitative HBsAg had been suggested to be helpful in management of HBV, but assays were cumbersome. The recent availability of commercial quantitative assays has restarted the interest in quantitative serum hepatitis B surface antigen (HBsAg) as a biomarker for prognosis and treatment response in chronic hepatitis B. HBsAg level reflects the transcriptional activity of cccDNA rather than the absolute amount of cccDNA copies. Serum HBsAg level tends to be higher in hepatitis B e antigen (HBeAg)-positive than HBeAg-negative patients. Among patients with a low HBV DNA (<2000IU/ml), HBsAg <1000IU/ml in genotype D HBV infection and HBsAg <100IU/ml in genotype B/C HBV infection is associated with inactive carrier state in HBeAg-negative patients. The HBsAg reduction by nucleos(t)ide analogues (NA) is not as pronounced as by interferon treatment. On peginterferon treatment, sustained responders tend to show greater HBsAg decline than the non-responders. The optimal on-treatment HBsAg cutoff to predict response needs further evaluation in HBeAg-positive patients, but an absence of HBsAg decline together with a <2 log reduction in HBV DNA at week 12 can serve as stopping rule in HBeAg-negative patients with genotype D HBV infection. A rapid serum HBsAg decline during NA therapy may identify patients who will clear HBsAg in the long-term. There are early reports among Asian patients that an HBsAg level of <100IU/ml might predict lower risk of relapse after stopping NA treatment. In clinical practice, serum HBsAg level should be used together with, but not as a substitute for, HBV DNA.

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