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Hepatitis B surface antigen loss after discontinuing nucleos(t)ide analogue for treatment of chronic hepatitis B patients is persistent in White patients

AuthorsSuárez, Emilio; Buti, María; Rodríguez, Manuel; Prieto, Martín; Pascasio, Juan Manuel; Casanovas, Teresa; Crespo García, Javier; Tapiador, Juan Arenas Ruiz; Gómez-Rodríguez, Rafael; Figueruela, Blanca; Diago, Moisés; Morillas, Rosa María; Zozaya, José Manuel; Calleja, José Luis; Casado, Marta CSIC ORCID ; Molina, Esther; Fuentes, Javier; Simón, Miguel Ángel
KeywordsChronic hepatitis B
Hepatitis B surface antigen
Hepatitis B virus reactivation
Hepatocellular carcinoma
Nucleos(t)ide analogue treatment
Issue DateFeb-2019
PublisherLippincott Williams & Wilkins
CitationEuropean Journal of Gastroenterology and Hepatology 31(2): 267-271 (2019)
Abstract[Objective]: The objective of this study was to determine the long-term clinical outcome and persistence of hepatitis B surface antigen (HBsAg) loss after discontinuation of treatment. [Background]: The prognosis of patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogues (NAs) who discontinue treatment after loss of HBsAg remains largely unknown, particularly in White patients. [Patients and methods]: We analysed a cohort of patients with CHB who discontinued NA treatment after loss of HBsAg. A total of 69 patients with hepatitis-B-e antigen-positive or hepatitis-B-e antigen-negative CHB with undetectable HBsAg during NA treatment were included after discontinuation of treatment, and followed up for a median period of 37.8 months (interquartile range: 23.8–54.6 months). [Results]: At the end of follow-up, none of the patients showed spontaneous reappearance of HBsAg and only one patient had detectable hepatitis B virus DNA (22 IU/ml). Another patient negative for HBsAg and anti-HBs developed hepatitis B virus reactivation without elevated transaminases after treatment with corticosteroids and vincristine for dendritic cell neoplasm, 38 months after withdrawal of the antiviral treatment. Regarding clinical outcome, a patient with cirrhosis developed hepatocellular carcinoma, 6.6 years after discontinuing treatment. None of the patients had hepatic decompensation or underwent liver transplantation. [Conclusion]: HBsAg clearance after discontinuing NAs in patients with CHB is persistent and associated with good prognosis. The risk for developing hepatocellular carcinoma persists among patients with cirrhosis.
Publisher version (URL)http://dx.doi.org/10.1097/MEG.0000000000001289
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