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HBEAG LOSS RATE DURING NUC THERAPY WAS LOWER THAN
NATURAL HISTORY IN CHB HBEAG POSITIVE PATIENTS WITH
HEPATITIS FLARE
Chien-Wei Peng1,2, Wen-Juei Jeng2,3 and Yun-Fan Liaw2,4,
(1)Department of Gastroenterology and Hepatology,
Chang Gung Memorial Hospital, Linkou Branch, (2)College
of Medicine, Chang Gung University, (3)Department of
Gastroenterology and Hepatology, Chang Gung Memorial
Hospital, Linkou Branch, Taiwan, (4)Liver Research Unit,
Chang Gung Memorial Hospital, Linkou Branch
Background: Spontaneous HBeAg loss rate was reported
to be 31% within three months and 62% within one year
after hepatitis flare (AE: ALT ³ 5X ULN) with AFP ³ 100ng/
ml in natural history The elevation of AFP has been known
related to histologic bridging hepatic necrosis. Such flare
with AFP ³ 100ng/ml has also associated with rapid HBsAg
decline during Nuc therapy. However, the influence of AFP
level on the HBeAg loss rate as compared with that in
untreated setting is unknown Thus, we aimed to clarify
the impact of AFP on HBeAg loss rate during Nuc therapy
Methods: HBeAg positive chronic hepatitis B patients who
received Nuc therapy with proper measurement of AFP level
in the beginning of treatment were recruited Baseline age,
gender, cirrhosis, ALT, genotype, HBsAg and HBV DNA
levels were analyzed. Serum HBV DNA was measured by
Cobas Amplicor HBV Monitor (Roche Diagnostics, negative
<20IU/ml), HBsAg was measured using Roche Elecsys II
kit (negative <0,05 IU/ml) Results: A total of 293 HBeAg
positive patients with 320 treatment course were analyzed
The median age was 44 3 (17 8~77 6) year-old, 72 2% were
males, 55 9% were genotype B, 44 1% were genotype C and
24 7% were cirrhotics Of these patients, 208 (65%) showed
HBeAg loss at a median time of 11 6 (0 4-104 4) months of
therapy during median follow-up duration of 56.6 months: 41
(12 8%), 107 (33 4%) within 3 months and 1 year respectively
One-year HBeAg loss rate in patients with baseline ALT level
< 5X, 5-10X, 10-20X, > 20X ULN was 17.2%, 24.2%, 37.9%,
and 51 5%, respectively (P<0 0001); AFP level < 20, 20-100,
³100 was 26.8%, 38.0%, 48.6%, respectively (P=0.0005).
Among patients with AE, HBeAg loss rate in AFP < 20, 20-
99, ³100 was 34.3%, 40.4%, 48.6%, respectively (P=0.0894).
The patients with AE and AFP > 100ng/ml HBeAg loss rate
within 3 months and one year were 26% and 49%, lower than
the spontaneous HBeAg loss rate reported (31% and 62%)
Among the 142 patients off-Nuc therapy, 38 patients showed
HBeAg reversion (26 7%) Conclusion: The 1-year HBeAg
loss rate during Nuc therapy has dose dependent relationship
with on-treatment ALT level and AFP level However, HBeAg
seroconversion rate by 3-month and one year on-treatment
was lower than that reported in the untreated setting It is
possible that Nuc therapy may decrease HBsAg antigen
and halt the endogenous host immune driving toward
HBeAg loss or halt the virus evolution by direct replication
suppression. 作者: StephenW 时间: 2019-10-29 19:46