Robust antiviral responses in severe hepatitis flare persist after early retreatment cessation and lead toward HBsAg loss: A proof-of-concept study
Ming-Ling Chang 1 , Rong-Nan Chien 1 , Yun-Fan Liaw 1
Affiliations
Affiliation
1
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine Taipei, Taoyuan, Taiwan.
PMID: 35716249 DOI: 10.1111/hepr.13804
Abstract
Aim: Hepatitis B flare has been interpreted as result of immune response against upsurging hepatitis B virus (HBV) and its antigen(s) that may lead to HBV decline/clearance spontaneously. It has been speculated that antiviral therapy could halt the effective immune response with viral persistent as a consequence. A proof-of-concept study was conducted to investigate this issue.
Methods: Serial biochemical, quantitative hepatitis B surface antigen (HBsAg), interferon-γ (IFN-γ) and tumor-necrosis factor-α (TNF-α) assays were performed in 4 patients with severe hepatitis flare who had achieved precipitous HBsAg decline within 4 weeks of antiviral therapy.
Results: TNF-α and IFN-γ were found to be elevated in parallel to upsurging HBV DNA and HBsAg levels in all patients. Higher levels of TNF-α and IFN-γ and levels relative to qHBsAg were observed during and after early termination of therapy within 4 weeks in 2 patients and were followed by further HBsAg decline to <5 IU/mL and even achieved HBsAg loss in one patient. The patient who had stopped therapy on day 44 showed minimal HBsAg decline afterward and the patient who continued therapy showed a 10-fold rebound of qHBsAg from its nadir. The subsequent IFN-γ and TNF-α activity of these two patients was minimal.
Conclusions: The results suggest that patients with severe hepatitis flare who achieved precipitous HBsAg decline may have robust immune response to clear the virus, and early termination of antiviral therapy may allow the protective immune response to continue and accelerate HBV decline toward HBsAg loss. This article is protected by copyright. All rights reserved.