Abstract
Background/aimsLittle is known about the long-term outcome of chronic hepatitis B (CHB) patients who discontinued antiviral therapy. We intended to analyze the long-term outcome of CHB patients who discontinued lamivudine therapy and to evaluate predictors for post-treatment outcome.Material/methodsFrom 2007 to 2008, 138 lamivudine off-treated CHB patients with alanine aminotransferase normalization were consecutively enrolled. Post-treatment virologic relapse, biochemical breakthrough, hepatitis flare, and retreatment results were retrospectively analyzed.ResultsAmong 138 patients, 102 were initially HBeAg-positive at the start of lamivudine treatment. Virologic relapse, biochemical breakthrough, and hepatitis flare were observed in 45.2, 52.9, and 12.7% of HBeAg-positive and 29.4, 30.6, and 8.3% of HBeAg-negative patients during the median follow-up of 28 and 30 months, respectively. The cumulative virologic relapse and biochemical breakthrough rates were significantly lower in patients with HBV DNA <50 copies/mL than 50-104 copies/mL at lamivudine cessation. Hepatitis flare was observed in 4.8 and 11.8% of HBeAg-positive and HBeAg-negative patients with HBV DNA <50copies/mL, respectively. Thirty-eight among 138 patients received retreatment and most of them achieved biochemical (37/38) and virologic response (35/38) within 1 year of retreatment. Undetectable serum HBV DNA (<50 copies/mL) and young age at lamivudine cessation were inversely associated with virologic relapse. Undetectable HBV DNA at cessation, female, and initial HBeAg-negative were inversely associated with biochemical breakthrough.ConclusionsPost-treatment virologic relapse and biochemical breakthrough incidence were low in patients who achieved undetectable viral titer at lamivudine cessation. Retreatment after biochemical breakthrough or virologic relapse was safe and effective. Intermittent antiviral therapy might be cautiously considered in appropriately selected CHB patients.
Highlights
Chronic hepatitis B (CHB) infection is estimated to affect about 350 million persons worldwide [1]
The cumulative virologic relapse and biochemical breakthrough rates were significantly lower in patients with Hepatitis B virus (HBV) DNA
Post-treatment virologic relapse and biochemical breakthrough incidence were low in patients who achieved undetectable viral titer at lamivudine cessation
Summary
Chronic hepatitis B (CHB) infection is estimated to affect about 350 million persons worldwide [1]. Trials for discontinuation of sustained lamivudine therapy have been issued [12,13]. Several CHB treatment guidelines recommend that lamivudine could be discontinued after consolidation therapy of at least 612 months following achievement of undetectable serum HBV DNA level and/or HBeAg loss/seroconversion [3,8,14,15]. Stopping lamivudine therapy is not always easy since virologic relapse or biochemical breakthrough including hepatitis flare are important concerns both for CHB patients and clinicians [16]. Posttreatment virologic relapse is not rare, but the definite endpoint of lamivudine therapy still remains to be elucidated [12,13,17]. Little is known about the long-term clinical course of CHB patients who discontinued lamivudine therapy in terms of hepatitis flare and retreatment result, and factors affecting long-term outcomes of patients who discontinued lamivudine therapy are still unclear
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