The impact of residual amount of serum hepatitis B virus DNA on the recurrence of chronic hepatitis B after stopping nucleoside(acid)analogue

Abstract

Objective To explore the recurrence of chronic hepatitis B(CHB)after stopping nucleoside(acid)analogue(NAs)and the impact of residual amount of serum hepatitis B virus(HBV)DNA on recurrence. Methods Seventy-nine CHB patients, who received treatment of NAs and achieved standard withdrawal were enrolled in this study. According to lab examination, there were 47 hepatitis B e antigens(HBeAg)-positive patients and 32 HBeAg-negative patients. Meanwhile, 33 CHB patients received lamivudine treatment(LAM group), 27 CHB patients received adefovir treatment(ADV group), and 19 CHB patients received entecavir treatment(ETV group). The biochemical and virological indicators of CHB patients' recurrence would be recorded after 48 weeks. Results There were 43 CHB patients(54.4%), whose indicators of HBV DNA turned positive after discontinuity of treatment with NAs of 48 weeks. There were 27 CHB patients(55.3%), the HBV DNA of whom turned positive among 47 HBeAg-positive patients, and 17 patients(53.1%)among 32 HBeAg-negative patients, and there was no significant difference(P > 0.05). In addition, the positive conversion rate after stopping treatment with NAs of 48 weeks in LAM group, ADV group and ETV group had no significant difference: 54.5%(18/33), 51.9%(14/27), 11/19, P > 0.05. Moreover, there were 36 patients(45.6%)whose index of alanine aminotransferase(ALT)increased again after discontinuity of treatment with NAs of 48 weeks. There were 20 CHB patients(42.6%)in HBeAg-positive patients, and 16 patients(50.0%)in HBeAg-negative patients, and there was no significant difference(P > 0.05). The rate of ALT increase again in LAM group, ADV group and ETV group had no significant difference: 48.5%(16/33), 40.7%(11/27), and 9/19, P > 0.05. According to the results of serum samples of 79 CHB patients with Roche reagent when stopping using NAs, in 35 CHB patients(44.3%)serum HBV DNA > 12 × 103 U/L was detected. However, serum HBV DNA > 5 × 105 U/L was detected in 25 CHB patients(71.4%)among 35 patients with serum HBV DNA > 12 × 103 U/L after 48 weeks, and merely in 18 CHB patients(40.9%)among 44 patients with serum HBV DNA < 12 × 103 U/L, and there was significant difference(P < 0.01). Conclusions The CHB patients with standard withdrawal still have high recurrence rate after stopping treating, whatever medicine was used. Then, residual amount of serum HBV DNA is an important indicator for predicting relapse of CHB. Meanwhile, the retreatment of these patients should be researched further. Key words: Hepatitis B, chronic; Recurrence; Nucleoside(acid)analogue; Drug withdrawal; Retrospective studies