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
Hepatitis B surface antigen (HBsAg) levels have been studied in the natural course and pegylated interferon treatment course. During nucleos(t)ide analogue (NA) therapy, there are still controversies about using HBsAg to predict treatment responses, especially in HBeAg-negative patients. Besides, HBsAg kinetics and its relationships with outcomes during long-term entecavir therapy have not been fully elucidated.
We hoped to elucidate the utility of HBsAg in the prediction of treatment response in HBeAg-positive and HBeAg-negative patients. Furthermore, we would like to demonstrate the detailed HBsAg kinetics among different disease statuses and their relationships with the treatment outcomes.
We aimed to investigate the utility and kinetics of serum HBsAg in chronic hepatitis B patients during long-term entecavir treatment.
We conducted this retrospective study to analyze the relationships between HBsAg levels and treatment responses in treatment-naïve chronic hepatitis B patients receiving at least two 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. Serum HBsAg levels were determined at baseline, one year and five year time points. The cumulative incidence of treatment responses were obtained using the Kaplan-Meier analysis. Multivariate analysis was performed using Cox proportional hazards regression. A linear mixed model with a random intercept was used for analysis of longitudinal changes of HBsAg levels.
We demonstrated that baseline HBsAg levels could be used to predict treatment responses in HBeAg-positive patients with a cut-off value of 4 log IU/mL and in HBeAg-negative non-cirrhotic patients with a cut-off value of 2.4 log IU/mL. Furthermore, our study provides a global view of HBsAg kinetics in chronic hepatitis B patients during long-term entecavir therapy. The HBeAg-positive non-cirrhotic group had the highest HBsAg levels at the baseline and throughout entecavir treatment, as compared with the other three patient groups. Higher rates of HBsAg decrease were observed in the first year for patients with higher baseline HBsAg levels. A rapid HBsAg decline did not necessarily guarantee better outcomes
Baseline HBsAg levels could be used to predict virological, serological, and biochemical responses. In the interpretation of HBsAg changes, HBeAg levels and decrease rates should be considered together according to a patient’s disease status.
HBsAg is a useful biomarker for chronic hepatitis B patients receiving NA therapy. It deserves to be studied in large prospective cohorts with different comorbidities for the future research.