Novel Viral Markers and the Prediction of Off-treatment Relapse in Chronic Hepatitis B Patients: A Systematic Review
Aunchalee Jaroenlapnopparat 1 , Maneerat Chayanupatkul 1 , Pisit Tangkijvanich 2
Affiliations
Affiliations
1
Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
2
Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
PMID: 33811375 DOI: 10.1111/jgh.15516
Abstract
Background: Hepatitis B core-related antigen (HBcrAg) and hepatitis B virus RNA (HBV RNA) are novel markers that reflect intrahepatic cccDNA and could be useful in the prediction of relapse after nucleos(t)ide analogues (NA) discontinuation.
Aim: To perform a systematic review on this issue.
Methods: Medline/Pubmed database was searched using text terms related to HBcrAg, RNA, NAs, discontinuation, and relapse. Included studies were those that enrolled adult patients who had been on NAs for more than 6 months with available information on end-of-treatment (EOT) HBcrAg and/or HBV RNA and relapse rates.
Results: Sixteen studies were included. Virological and clinical relapse rates ranged from 11-100% and 11-73%, respectively. Low or undetectable EOT HBcrAg levels were associated with low off-treatment relapse rates in most studies with area under the receiver operating characteristic curve (AUROC) of 0.69-0.70 for predicting virological relapse (VR) and 0.61-0.77 for predicting clinical relapse (CR). Undetectable EOT HBV RNA was associated with a lower risk of off-treatment relapse with AUROC of 0.65-0.76 for predicting VR and 0.66-0.73 for predicting CR. Combined EOT HBcrAg and HBV RNA performed better in predicting off-treatment relapse than either test alone with AUROC of 0.816-0.846 for predicting CR. None of the patients with double negative HBV RNA and HBcrAg developed clinical relapse.
Conclusion: Combining HBcrAg with HBV RNA or HBsAg improved the discriminating abilities in the prediction of off-treatment relapse of each test. Patients with double-negative HBcrAg and HBV RNA at EOT had low risks of relapse and could be considered for NA discontinuation.
Keywords: Chronic hepatitis B; Hepatitis B core-related antigen; Hepatitis B virus RNA; Nucleos(t)ide analogues; Relapse.
This article is protected by copyright. All rights reserved. 作者: StephenW 时间: 2021-4-4 10:28