Y. Liang and J. Jiang have contributed equally to this work.
Predictors of relapse in chronic hepatitis B after discontinuation of anti-viral therapy
Article first published online: 14 JUN 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 34, Issue 3, pages 344–352, August 2011
How to Cite
Liang, Y., Jiang, J., Su, M., Liu, Z., Guo, W., Huang, X., Xie, R., Ge, S., Hu, J., Jiang, Z., Zhu, M., Wong, V. W.-S. and Chan, H. L.-Y. (2011), Predictors of relapse in chronic hepatitis B after discontinuation of anti-viral therapy. Alimentary Pharmacology & Therapeutics, 34: 344–352. doi: 10.1111/j.1365-2036.2011.04738.x
- Issue published online: 4 JUL 2011
- Article first published online: 14 JUN 2011
- Publication data , Submitted 3 March 2011, First decision 10 April 2011, Resubmitted 18 May 2011, Accepted 25 May 2011, EV Pub Online 14 June 2011
Vol. 34, Issue 11-12, 1358, Article first published online: 16 NOV 2011
Aliment Pharmacol Ther 2011; 34: 344–352
Background Optimal duration of anti-viral therapy in chronic hepatitis B virus (HBV) infection remains unclear.
Aim To investigate factors that could predict relapse after stopping anti-viral agents.
Methods Chronic hepatitis B patients who were treated with anti-viral agents (lamivudine, adefovir, entecavir) and have stopped the treatment were recruited. Anti-viral agents were stopped according to the recommendations of the Asian Pacific Association for the Study of the Liver. Virological relapse was defined as an increase in serum HBV DNA to >1000 copies/mL after discontinuation of treatment.
Results Eighty-four (69 treatment naïve and 15 lamivudine resistant) patients were eligible for this study. Thirty-seven patients developed virological relapse at 4.3 ± 2.9 (range 1–11) months after discontinuation of therapy. The 1-year cumulative probability of virological relapse was 42% and 47% in HBeAg (hepatitis B e antigen)-positive (n = 41) and HBeAg (hepatitis B e antigen)-negative (n = 43) patients, respectively. On multivariate analysis by Cox proportional hazard model, pre-existing lamivudine resistance, delayed suppression of HBV DNA to undetectable level during anti-viral therapy and to a higher HBsAg (hepatitis B surface antigen) level at the end of treatment were associated with virological relapse. Twelve of the 15 (80%) lamivudine resistant patients developed virological relapse. Among the 11 treatment naïve patients who had HBsAg ≤2 log IU/mL at the end of treatment, 1 (9%) of them had virological relapse.
Conclusions Treatment cessation among lamivudine resistant patients is associated with high risk of virological relapse. Serum HBsAg level at the end of treatment and rate of HBV DNA suppression can provide supplementary information to guide the timing of stopping anti-viral drugs.