AASLD2019[464]术中HBsAg动力学与 核（T）终止后的HBsAg动力学 非

StephenW

464
ON-THERAPY HBsAg KINETICS ARE ASSOCIATED WITH
HBsAg KINETICS AFTER DISCONTINUATION OF NUCLEOS(T)
IDE ANALOGUES (NA) IN NON-CIRRHOTIC HBEAG-NEGATIVE
CHRONIC HEPATITIS B (CHBE-)
George V Papatheodoridis, Department of Gastroenterology,
Medical School of National and Kapodistrian University of
Athens, General Hospital of Athens “Laiko”, Athens, Greece,
Emilia Hadziyannis, 2nd Department of Internal Medicine,
Medical School of National and Kapodistrian University of
Athens, General Hospital of Athens “Hippokratio”, Athens,
Greece and Stephanos J. Hadziyannis, Liver Clinic, Athens,
Greece
Background: NA discontinuation in non-cirrhotic CHBepatients
has been shown to increase the probability of HBsAg
loss, but, except for HBsAg levels, clear predictors of such
an outcome remain unclarified. We assessed whether HBsAg
kinetics during NA therapy are associated with the probability
of HBsAg loss and HBsAg kinetics after stopping long-term
effective NA therapy Methods: We included 33 non-cirrhotic
adult Caucasians with CHBe- who discontinued adefovir after
4 (n=12) or 5 (n=21) years (baseline age 54±12 years, males
82%) All patients had maintained on-NA virological remission
for ≥36 (median 50) months and were HBsAg positive at
NA cessation Post-NA follow-up was performed at months
1,2,3,4,6,9,12 and every ≤6 months thereafter. Median
follow-up after stopping NA was 24 months (until HBsAg
loss or retreatment), but all untreated patients remaining
HBsAg positive were followed for >60 months. Results: At
NA cessation, mean HBsAg levels were 2 9±1 4 log10 IU/mL
During post-NA follow-up, virological relapse (HBV DNA >2000
IU/mL at ≥1 visit) was observed in 28 (85%) and retreatment
was initiated in 15 (45%) patients, while 16 (48%) patients
lost HBsAg (1-, 2-, 3-, 5-year cumulative rate: 10%, 23%,
33%, 48%). Median HBsAg decline per year was significantly
higher after than during NA (0 69 vs 0 05 log, P<0 001), while
there was a significant correlation between HBsAg decline
per year during and after therapy (r=0 520, P=0 003) Ontherapy
HBsAg decline per year was significantly associated
with the probability of HBsAg loss after NA cessation [RH per
log: 12.08 (95% CI: 1.61-90.49), P=0.015], which was higher
in patients with on-therapy HBsAg decline ≥0.05 than <0.05
log/year (1-, 3-, 5-year cumulative rate: 19%, 43%, 67% vs
0%, 22%, 33%; log-rank, P=0 032) HBsAg loss after was
also associated with HBsAg levels [RH per log: 0.30 (0.17-
0.52), P<0.001] and HBsAg ≤3 (vs >3) log at NA cessation
(1-, 3-, 5-year cumulative rate: 23%, 39%, 69%; log-rank,
P=0 003) In multivariable Cox regression analysis, HBsAg
levels or HBsAg <3 log at NA cessation but not on-therapy
HBsAg decline was significantly associated with subsequent
HBsAg loss Conclusion: In Caucasian CHBe- patients who
discontinue long-term NA therapy, on-therapy HBsAg kinetics
are associated with HBsAg kinetics and the probability of
HBsAg loss after NA cessation However, HBsAg levels at
treatment discontinuation represent the strongest predictor of
subsequent HBsAg loss.

StephenW

464
术中HBsAg动力学与
核（T）终止后的HBsAg动力学
非肝硬化人HBEAG阴性的IDE模拟（NA）
慢性乙型肝炎（CHBE-）
胃肠病学系George V Papatheodoridis，
国立和卡波德斯第安大学医学院
雅典，雅典“ Laiko”总医院，希腊雅典，
内科第二系Emilia Hadziyannis
国立和卡波德斯第安大学医学院
雅典，雅典“ Hippokratio”综合医院，雅典，
希腊和雅典肝脏诊所的Stephanos J.Hadziyannis，
希腊
背景：非肝硬化儿童的NA停用
已显示出增加HBsAg的可能性
丢失，但除HBsAg水平外，明确的预测指标
结果尚不清楚。我们评估了HBsAg是否
NA治疗期间的动力学与概率相关
长期停药后HBsAg丢失和HBsAg动力学的变化
有效的NA治疗方法：我们纳入了33种非肝硬化患者
CHBe-的成年高加索人，在停药后停用阿德福韦
4（n = 12）或5（n = 21）岁（基线年龄54±12岁，男性
82％）所有患者均维持NA病毒学缓解
≥36（中位数50）个月且HBsAg阳性于
NA停止NA后的随访时间为几个月
1,2,3,4,6,9,12，此后每≤6个月。中位数
停用NA后的随访时间为24个月（直到HBsAg
丢失或再次治疗），但所有未治疗的患者仍在
HBsAg阳性随访超过60个月。结果：
NA停止，平均HBsAg水平为2 9±1 4 log10 IU / mL
NA后随访期间，病毒学复发（HBV DNA> 2000
观察到IU / mL≥1次）（28％（85％）），并再次治疗
15例（45％）患者开始接受治疗，而16例（48％）患者开始接受治疗
HBsAg丢失（1、2、3、5年累积率：10％，23％，
33％，48％）。每年HBsAg中位数下降显着
之后高于NA（0 69 vs 0 05 log，P <0 001），而
HBsAg下降之间存在显着相关性
治疗期间和之后每年（r = 0 520，P = 0 003）
每年HBsAg下降显着相关
停止NA后HBsAg丢失的可能性[RH per
log：12.08（95％CI：1.61-90.49），P = 0.015]，该值较高
接受治疗的HBsAg下降≥0.05且<0.05的患者
log / year（1-，3-，5年累计率：19％，43％，67％vs
0％，22％，33％；对数秩，P = 0 032）之前的HBsAg丢失
也与HBsAg水平相关[每日志RH：0.30（0.17-
0.52），P <0.001]和HBsAg≤3（vs> 3）在NA停止时的对数
（1、3、5年累积率：23％，39％，69％；对数排名，
P = 0 003）在多变量Cox回归分析中，HBsAg
停药但不接受治疗时HBsAg水平或<3 log的水平
HBsAg下降与随后的
HBsAg丢失结论：在白种人CHBe-患者中
停止长期NA治疗，治疗中HBsAg动力学
与HBsAg动力学和
NA停止后HBsAg丢失然而，
治疗中止代表了最强的预测因素
随后的HBsAg丢失。