Z Gastroenterol 2011; 49 - V4_03
DOI: 10.1055/s-0030-1269706

Relevance of quantitative HBsAg (qHBsAg) during long-term treatment of chronic hepatitis B with nucleos(t)ide analogues (NUCs)

J Jaroszewicz 1, H Ho 1, K Deterding 1, A Markova 1, K Wursthorn 1, HL Tillmann 2, S Schulz 1, TC Bock 3, MP Manns 1, H Wedemeyer 1, M Cornberg 1
  • 1Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover
  • 2Duke Clinical Research Institute, GI/Hepatology Research Program, Division of Gastroenterology, Durham, North Carolina, USA
  • 3Robert Koch-Institut, Berlin

qHBsAg has been show to predict response to interferon alfa but may also be useful to dissect the phase of HBV-infection. The aim of this study was to analyze if qHBsAg is useful for the prediction of HBsAg loss during NUC therapy. HBsAg was quantified in 126 patients with chronic HBV-infection. 95 patients received therapy with NUCs and were followed for 6–107 months. 31 patients not receiving therapy were observed for 36–48 months. We further analyzed serum cytokines by CBA to find additional markers for HBsAg loss. Six patients on NUCs achieved HBsAg loss. Patients with HBsAg loss had higher baseline ALT and higher serum IP-10 levels suggesting ongoing immune responses that eventually support control of HBV. We distinguished 3 pattern of HBsAg decline: 1) strong decline (>0.5 log), 2) moderate decline (10%-0.5 log), 3) no decline (<10%). HBsAg kinetics after 6 months of NUC therapy were not predictive for later HBsAg loss (p=0.34). However, HBsAg kinetics in the first 2 years after achieving HBV-DNA <100 IU/mL were strongly predictive for HBsAg loss (p<0.001): 19% of NUC treated had a strong HBsAg decline, 53% showed a moderated decline, and 28% showed no decline. Only patients with a strong HBsAg decline after HBV-DNA suppression experienced HBsAg loss and also showed higher serum IP-10 levels than patients with no decline (690.7 vs. 196.6 pg/ml, p=0.04). Interestingly, patients without anti-HBV treatment had similar dynamics of HBsAg: 19% strong HBsAg decline, 55% moderate decline, and 26% no decline. Our data suggests that HBV-DNA suppression may be the first milestone for HBsAg loss as kinetics after HBV-DNA suppression was predictive. However, immune events may play a crucial role as higher serum IP-10 levels were associated with HBsAg loss and patients who received no antiviral therapy had similar HBsAg kinetics during the natural course of HBV-infection. The study highlights the value of qHBsAg for the prediction of HBsAg loss during NUC therapy.

HBV - chronic hepatitis B - nucleos(t)ide analogues - quantitative HBsAg