Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2014; 20(26): 8722-8725
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8722
HBsAg clearance by Peg-interferon addition to a long-term nucleos(t)ide analogue therapy
Michele Barone, Andrea Iannone, Alfredo Di Leo
Michele Barone, Gastroenterology Unit, Department of Medical and Surgical Science, University of Foggia, 71122 Foggia, Italy
Andrea Iannone, Alfredo Di Leo, Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, 70124 Bari, Italy
Author contributions: Barone M and Iannone A contributed equally to this work and wrote the paper; Di Leo A approved the final version.
Correspondence to: Michele Barone, MD, PhD, Professor of Medicine, Chief of Gastroenterology Unit, Department of Medical and Surgical Science, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy. michele.barone@unifg.it
Telephone: +39-0881-733848 Fax: +39-0881-7332135
Received: January 20, 2014
Revised: March 10, 2014
Accepted: April 5, 2014
Published online: July 14, 2014
Processing time: 175 Days and 14.7 Hours
Abstract

The ideal endpoint of hepatitis B virus (HBV) antiviral therapy is HBsAg loss, a difficult goal to obtain, especially in HBeAg negative patients. Herein, we report the results obtained by the addition of peg-interferon α-2a to a long-lasting nucleos(t)ide analogue therapy in a HBeAg negative, genotype D patient with steadily HBV-DNA negative/HBsAg positive values. In 2002, our Caucasian 44-year-old male patient received lamivudine and, 4 years later, added adefovir because of a virological breakthrough. In 2011, considering his young age, liver stiffness (4.3 kPa) and HBsAg levels (3533 IU/mL), we added Peg-interferon α-2a for six months (3 in combination with nucleos(t)ide analogues followed by 3 mo of Peg-interferon α-2a monotherapy). A decrease of HBsAg levels was observed after 1 mo (1.21 log) of Peg-interferon and 3 mo (1.88 log) after the discontinuation of all drugs. Later, a complete clearance of HBsAg was obtained with steadily undetectable HBV-DNA serum levels (< 9 IU/mL). HBsAg clearance by the addition of a short course of Peg-interferon α-2a represents an important result with clinical and pharmaco-economic implications, considering that nucleos(t)ide analogues therapy in HBeAg negative chronic hepatitis B patients is considered a long-lasting/life-long treatment.

Keywords: Addition; HBeAg negative; HBsAg clearance; Nucleos(t)ide analogues; Peg-interferon

Core tip: The ideal endpoint of antiviral therapy is HBsAg loss, a difficult goal to obtain, especially in HBeAg negative patients. A Caucasian 44-year-old male patient, HBeAg negative, genotype D, received lamivudine and, 4 years later, added adefovir because of a virological breakthrough. Five years later, considering his age, liver stiffness (4.3 kPa) and HBsAg levels (3533 IU/mL), we added Peg-interferon α-2a for six months (3 in combination with nucleos(t)ide analogues followed by 3 of Peg-interferon monotherapy), obtaining a complete HBsAg clearance. This result has important clinical and pharmaco-economic implications, since nucleos(t)ide analogues therapy in HBeAg negative patients is considered a long-lasting/life-long treatment.