Spontaneous Undetectable Hepatitis B Virus DNA Is Uncommon

StephenW

<http://www.hivandhepatitis.com/2 ... cs/0514_2010_c.html>

HIV and Hepatitis.com Coverage of the
45th Annual Meeting of the European
Association for the Study of the Liver (EASL 2010)
April 14 - 18, 2010, Vienna, Austria

Spontaneous Undetectable Hepatitis B Virus DNA Is Uncommon, especially without
HBeAg Clearance

   
  SUMMARY: Clearance of hepatitis B virus (HBV) DNA from the blood seldom
occurs without treatment even after a decade, researchers reported at the 45th
Annual Meeting of the European Association for the Study of the Liver (EASL
2010) last month in Vienna. Among people who experience hepatitis B "e"
antigen (HBeAg) clearance, however, the likelihood of also achieving
undetectable viral load was higher, approaching 50% at 10 years.

   
By Liz Highleyman
C-J. Chen from National Taiwan University and colleagues assessed the
likelihood and factors associated with spontaneous clearance of HBV viral load
in a sub-study of the large REVEAL-HBV trial, which looked at long-term
outcomes including liver cancer among people with chronic hepatitis B.
The sub-study included 1289 participants with high HBV DNA levels (> 10,000
copies/mL) but no evidence of cirrhosis at study entry.
Results

199 participants (15.4%) achieved undetectable HBV DNA (< 100 copies/mL)
during follow-up.
HBV DNA became undetectable after an average of 7.8 years, for a clearance
rate of 19.7 per 100,000 person-years.
Overall, the cumulative likelihood of achieving undetectable HBV DNA was 5.2%
at 5 years and 14.5% at 10 years.
Looking only at participants who experienced HBeAg clearance, however,
cumulative HBV DNA clearance rates were higher, 11.5% at 5 years and 45.5% at
10 years.
In a multivariate analysis, having a baseline viral load of 100,000-999,999
copies/mL (versus> 1 million copies/mL) and abdominal obesity were associated
with greater likelihood of spontaneous HBV DNA clearance.
In contrast, elevated alanine aminotransferase (ALT) -- both 15-44 U/L and>
45 U/L versus < 15 U/L -- was associated with lower likelihood of achieving
undetectable HBV DNA.
Most participants (89%) who were initially HBeAg seropositive had already
cleared HBeAg by the time they achieved undetectable HBV DNA.
Conversely, a majority of participants had viral load> 10,000 copies/mL at
the time of HBeAg clearance.
"Spontaneous seroclearance of HBV DNA was a rare event, even after HBeAg
seroclearance," the investigators concluded. "Lower baseline viral load and
central obesity [were] associated with higher possibility of decreasing HBV
DNA to undetectable level, whereas higher serum ALT level during follow-up
associated with a lower possibility of HBV DNA decline."

Genomics Research Center, Academia Sinica, National Taiwan University, Taipei,
Taiwan ROC; Research and Development, Bristol-Myers Squibb Company,
Willingford, CT.
5/14/10

Reference
C-J Chen, H-I Yang, C-L Jen, and others. Incidence and determinants of
spontaneous decline of HBV DNA to undetectable level in patients with high
viral load. 45th Annual Meeting of the European Association for the Study of
the Liver (EASL 2010). Vienna, Austria. April 14-18, 2010. (Abstract).