Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.725
Peer-review started: October 18, 2017
First decision: November 8, 2017
Revised: November 17, 2017
Accepted: November 28, 2017
Article in press: November 28, 2017
Published online: February 14, 2018
To investigate the utility of hepatitis B surface antigen (HBsAg) kinetics in chronic hepatitis B patients during long-term entecavir treatment.
This retrospective study included treatment-naïve chronic hepatitis B patients who received at least 2 years of consecutive entecavir treatment. Patients were followed up at three to six month intervals with liver biochemistry, hepatitis B virus DNA, and abdominal sonography. In hepatitis B e antigen (HBeAg)-positive patients, HBeAg levels were assessed every three to six month until results became negative. Serum HBsAg levels were determined at the baseline, one-year and five-year time points. Liver cirrhosis was diagnosed through liver biopsy, imaging examinations, or clinical findings of portal hypertension. Hepatocellular carcinoma was diagnosed by histological examination or dynamic image studies.
A total of 211 patients were enrolled. The median treatment time was 5.24 (2.00-9.62) years. Multivariate analysis showed that lower baseline HBsAg levels were associated with an earlier virological response, earlier hepatitis B e antigen (HBeAg) seroconversion, and earlier biochemical response in HBeAg-positive patients (cut-off value: 4 log IU/mL) and an earlier virological response in HBeAg-negative non-cirrhotic patients (cut-off value: 2.4 log IU/mL). Although HBsAg levels decreased slowly during long-term entecavir treatment, higher HBsAg decrease rates were found in the first year for HBeAg-positive non-cirrhotic patients, and patients with higher baseline HBsAg levels. More favorable clinical outcomes were not observed by a rapid HBsAg decline per se, but depended on lower baseline HBsAg levels.
Baseline HBsAg can be used to predict treatment responses. HBsAg levels and decrease rates should be considered together according to disease status while interpreting HBsAg changes.
Core tip: Baseline hepatitis B surface antigen (HbsAg) levels could be used to predict virological, serological, and biochemical responses during entecavir treatment. HBeAg-positive non-cirrhotic patients had the highest HBsAg levels at the baseline and throughout entecavir treatment, and had the highest HBsAg decrease rates during the first year of entecavir treatment. HBsAg levels decrease slowly during the treatment. Therefore, HBsAg should be checked at a 1-year interval if hepatitis B virus DNA remains undetectable. A rapid HBsAg decline per se did not achieve better patient outcomes. In the interpretation of HBsAg changes, HBsAg levels and decrease rates should be considered together according to disease status.