Hepatic events in patients who achieved complete viral suppression with or without hepatitis B surface antigen seroclearance - A territory-wide cohort study of 17,725 subjects
Refereed conference paper presented and published in conference proceedings


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摘要Background: In patients with chronic hepatitis B (CHB) who achieved complete viral suppression in potent antiviral treatment, it is unclear if hepatitis B surface antigen (HBsAg) seroclearance confers additional protection against hepatic events. We compared the risk of hepatic events in treated patients who achieved complete viral suppression with and without HBsAg seroclearance.

Method: All CHB patients who had received first-line nucleos(t)ide analogues (NA), i.e. entecavir and/or tenofovir disoproxil fumarate, for at least 6 months from January 2005 to November 2016 were identified. Complete viral suppression was defined as undetectable serum HBV DNA (\20 IU/mL) while on NA treatment maintained till the last clinic visit. HBsAg seroclearance was defined as loss of HBsAg detectability for at least once. The primary outcome was a composite of hepatic events.

Result: We identified 17,725 NA-treated CHB patients. At a median (interquartile range [IQR]) follow-up of 4.0 (2.2–5.0) years, 482 patients developed hepatic events including ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatocellular carcinoma (HCC) and liver-related death based on the ICD-9-CM diagnosis codes. Complete viral suppression was achieved in 14,845 (83.6%) patients; 210 (1.4%) patients further had HBsAg seroclearance. Patients with complete viral suppression had a median (IQR) suppression duration of 1.8 (0.9–3.0) years; they were more likely to be male, had negative HBeAg, liver cirrhosis, lower platelet counts, serum total bilirubin and alanine aminotransferase (ALT), and less likely to have detectable hepatitis B virus (HBV) DNA at baseline as compared to the patients without complete viral suppression. Patients with HBsAg seroclearance were more likely to be male, less likely to have detectable HBV DNA at baseline, had higher platelet counts, serum total bilirubin and ALT. Compared to patients with complete viral suppression, patients without complete viral suppression had a significantly higher risk of hepatic events (adjusted hazard ratio [aHR] 3.00, 95% CI 2.42–3.72; P<0.001) after adjustment for important covariates; patients with HBsAg seroclearance did not have further
risk reduction (aHR 1.16, 0.46–2.94; P=0.759). Similar findings were observed for HCC, liver-related death, and all-cause death, with aHRs ranging from 2.42 to 5.33 for patients without complete viral suppression (all P\0.001), and aHRs ranging from 0.59 to 1.49 for patients with HBsAg seroclearance (P=0.337-0.817) (Figures 1-2). Sensitivity analysis on patients who received at least one year of treatment also showed similar results.

Conclusion: Patients who achieved complete viral suppression with NA treatment had similarly low risk of hepatic events, liver-related death, and all-cause death with or without HBsAg seroclearance.
著者Cheuk Fung Yip, Vincent Wai Sun Wong, Henry Lik Yuen Chan, Yee Kit Tse, Grace Lai Hung Wong
會議名稱The Asian Pacific Association for the Study of the Liver (APASL) 2018 Annual Meeting
會議開始日14.03.2018
會議完結日18.03.2018
會議地點New Delhi
會議國家/地區印度
會議論文集題名Hepatology International
出版年份2018
月份3
卷號12
期次Suppl 2
出版社Springer
頁次S352 - S353
國際標準期刊號1936-0533
電子國際標準期刊號1936-0541
語言英式英語

上次更新時間 2019-21-10 於 15:43