EASL2012:Unexpected increase of Hepatitis B Surface Antigen (HBsAg) concentratio

StephenW

Abstract               
                    

Title	Unexpected increase of Hepatitis B Surface Antigen (HBsAg) concentrations during treatment with nucleos(t)ide analogous 12-24 months before virological breakthrough and resistance
Speaker:	Steffen   Wiegand
Author:	S.B. Wiegand1*, J. Jaroszewicz1,2, B. Zacher1, K. Wursthorn1, K. Deterding1, M.P. Manns1, H. Wedemeyer1, M. Cornberg1
Affiliation:	1Department of Gastroenterology, Hepatology and Endocrinolgy, Hannover Medical School, Hannover, Germany, 2Uniwersytet Medyczny w Białymstoku, Bialystok, Poland. *[email protected]
Introduction: Hepatitis B Surface Antigen (HBsAg) concentrations differ in the course of chronic hepatitis B virus infection and may predict the response to treatment with interferon alpha. Recently, we have shown that significant HBsAg decline after HBV DNA suppression during treatment with nucleos(t)ide analogues (NA) is associated with later HBsAg loss (Jaroszewicz et al., AVT 2011). So far there is little data if resistance to NA affects HBsAg level. Methods: In this retrospective study, HBsAg was quantified longitudinally in 30 patients with virological breakthrough (VB) due to NA resistance (VB-R: 27 LAM, 3 ADV). We have selected a control group of 30 patients on NA therapy (4 LAM, 3 ADV, 6 LAM&ADV de novo, 13 ETV, 4 TdF) without VB who have been treated at least for 29 months (median time until resistance occured in VB-R). In addition 5 patients were analyzed who had VB due to non-compliance (NC). HBsAg was quantified in all patients using Roche Elecsys II, some samples were additionally tested by Abbot Architect. Results: HBsAg level increased significantly in patients with later VB and resistance. Surprisingly, the increase of HBsAg peaked 12-24 months before VB (Table). 20/30 patients showed an HBsAg increase to >120% at this time-point. A second smaller peak was detected at the time of VB. In contrast, HBsAg slowly declined in the control group and only 2 patients without VB showed an HBsAg increase to >120% at any time. Also, patients with VB due to non-compliance demonstrated a decrease in HBsAg until VB. Conclusion: HBsAg quantification may be a useful marker to monitor the outcome of NA therapy. A slow decline of HBsAg can be observed in most patients with maintained on-treatment virological response and a significant decline may even predict later HBsAg loss. However, an HBsAg increase may predict later NA-resistance more than 12 months before VB. The surprisingly early HBsAg increase 12-24 months before VB is unexpected and demands further research. [Figure]

                                                                                               
            
        
                  

StephenW

病毒学突破和抗乙肝表面抗原（HBsAg）浓度在12-24个月治疗核苷（酸）IDE类似前标题意外增加
主讲人：斯特芬·韦根
作者：S.B. wiegand1 *，J. Jaroszewicz1，2，B Zacher1，Wursthorn1光，光Deterding1，MP manns1，H. Wedemeyer1，M. Cornberg1
单位：胃肠病，肝病和Endocrinolgy，汉诺威医学院，汉诺威，德国，2Uniwersytet Medyczny瓦特Białymstoku，比亚韦斯托克，波兰1Department。 * cornberg.markus @ MH-hannover.de
简介：乙型肝炎表面抗原（HBsAg）的浓度不同在慢性乙型肝炎病毒感染的过程中，可预测与α-干扰素治​​疗的反应。最近，我们已经表明在核苷（酸）IDE类似物（NA）的治疗后HBV DNA抑制效果显着的HBsAg下降后HBsAg消失（Jaroszewicz等人。2011年，AVT）。到目前为止，很少有数据，如果无影响抗HBsAg水平。
方法：在本回顾性研究中，HBsAg的病毒学突破（VB），由于无阻力在30例（VB-R的议员，27日3 ADV），纵向量化。我们已选定适用治疗没有VB的（4林，3 ADV 6林及ADV的从头，13教育电视，4 TDF）曾治疗至少29个月（平均时间对照组30例，直到阻力中发生的VB R）此外，5例患者进行了分析，有VB由于不遵守（NC）的。乙肝表面抗原，在所有患者使用罗氏Elecsys II量化，一些样品进行额外测试由方丈建筑师。
结果：HBsAg水平在以后的VB和抵抗患者显着增加。令人惊讶的是，增加乙肝表面抗原VB（表）前12-24个月达到高峰。 20/30的患者表现为> 120％，乙肝表面抗原在这个时间点增加。第二个较小的峰值检测的VB的时间。相比之下，乙肝表面抗原缓慢下降，对照组只有2没有VB的患者表​​现为乙肝表面抗原在任何时间增加120％。此外，患者因不遵守用VB显示减少，直到VB的乙肝表面抗原。
结论：乙肝表面抗原定量可能会成为一个有用的标记，监测的NA治疗的结果。在一个缓慢下降的HBsAg可以观察到大多数患者维持治疗的病毒学应答和显着下降，甚至可能预测后HBsAg消失。然而，乙肝表面抗原的增加可以预测比VB的前12个月后无抵抗。令人惊讶的早期乙肝表面抗原增加12-24个月之前的VB是意想不到的，需要进一步研究。


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