Sa1045 Factors That Affect the Improvement of Liver Stiffness in Patients With Chronic Hepatitis B

Abstract

Background and aims Long term suppression of Hepatitis B virus (HBV) replication with nucleos(t)ide analogues (NA) is associated with biochemical improvement and viral suppression. However the factors affecting this response remain unclear. Method A cohort of 107 HBV infected patients undergoing treatment with NA at Royal North Shore Hospital (20002011) was studied. Demographic, viral, biochemical and histological data were collected prospectively during treatment and subjected to univariate and multivariate analysis. Result Seventy-eight percent of the total cohort were Asian, 70% were males and 47% had advanced fibrosis (F≥3) at baseline. Mean HBV DNA PCR was 5.62 log IU/mL and mean ALT was 129 IU/L at baseline. Mean duration of treatment was 66 months. There were 42 eAg positive and 65 eAg negative patients. In the combined cohort, 64% had undetectable DNA at week 48. Negative eAg at baseline, lower DNA at baseline, no interferon use (before or during the therapy), normalised ALT at week 48 and older age were associated with undetectable DNA at week 48. (p<0.05) However, logistic regression analysis identified baseline eAg negativity as the only significant predictor of undetectable DNA at week 48. (p=0.02) Sixtytwo percent had normalised ALT at week 48, and associated factors were undetectable DNA at week 48, shorter time to undetectable DNA and higher ALT at baseline. (p<0.05) Logistic regression identified shorter time to lowest DNA as the only predictor of normalised ALT at week 48. (p=0.02) In patients with positive eAg at baseline, 55% and 7% achieved eAg seroconversion (or loss) and sAg seroconversion (or loss) respectively. Older age and advanced fibrosis were significantly associated with eAg seroconversion and/or eAg loss. (p≤0.05) No patients developed progressive liver failure while on treatment in the absence of hepatocellular cancer. Conclusion NA therapy in the clinic setting is associated with effective long term viral suppression with improved eAg seroconversion in older patients and those with advanced fibrosis. Higher rates of sAg seroconversion or loss were observed in patients with positive eAg at baseline.