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1558
Long term clinical outcome in chronic hepatitis B patients
with partial virologic response to entecavir treatment
Kyu sik Chung, Hye Won Lee, Jun Yong Park, Hye Jin Ku, Beom
Kyung Kim, Seung Up Kim, Do Young Kim, Kwang-Hyub Han,
Sang Hoon Ahn; Department of Internal Medicine, Yonsei University
College of Medicine, Seoul, Korea (the Republic of)
Background: The aim of this study is to investigate whether
partial virological response (PVR) to entecavir (ETV) treatment
might affect long term clinical outcome including hepatocellular
carcinoma (HCC) and hepatic decompensation occurrence
or not. Methods: Treatment naïve chronic hepatitis B (CHB)
patients treated with ETV (0.5 mg/day) for at least 1 year
were subsequently followed up with regular surveillance of
liver relate events (LRE) occurrence which including HCC occurrence,
hepatic decompensation, liver-related mortality, and
liver transplantation. PVR was defined as a decrease in HBVDNA
titer of more than 1 log10IU/mL, by real time-polymerase
chain reaction, but with residual serum HBV-DNA, at week 48
of ETV therapy. Results: A total of 538 CHB patients (354males
and 184 females) were followed up for median 59.7 months.
At 48 weeks after ETV treatment, complete viral response (CVR,
HBV-DNA<20 IU/mL) was achieved in 392 (72.9%) patients
and PVR in 138 (25.7%) patients. In patients with PVR, CVR
was achieved in 63.8%, and 76.8% at 3- and 5- year after
ETV treatment, respectively. During follow-up, cumulative incidences
of HCC and LRE were comparable with patients with
CVR and those with PVR (P=0.135 and P=0.062, respectively).
In univariate analysis, old age, liver cirrhosis, and non-ALT normalization
at week 48 were related with HCC and LRE occurrence
(all P<0.05), whereas PVR was not significantly related
with HCC and LRE occurrence (both P>0.05). In multivariate
analysis, age and liver cirrhosis were selected as independent
risk factors of LRE occurrence (both P<0.001). In sub-group of
compensated cirrhosis, PVR was also not significantly related
with HCC and LRE occurrence (P=0.805). Conclusions: Patients
with PVR to ETV had favorable virological outcome and comparable
long term clinical outcome comparing those with CVR,
suggesting early rescue therapy for patient with PVR might not
be urgent unless patients are at high risk of hepatic decompensation
and HCC development.
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