Published online Apr 28, 2017. doi: 10.3748/wjg.v23.i16.2978
Peer-review started: December 23, 2016
First decision: January 19, 2017
Revised: February 18, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: April 28, 2017
Processing time: 127 Days and 17.1 Hours
To investigate whether hepatitis viral DNA load at 24 wk of treatment predicts response at 96 wk in patients with chronic hepatitis B.
A total of 172 hepatitis B envelope antigen (HBeAg)-positive chronic hepatitis B patients who received initial treatment at 16 tertiary hospitals in Hunan Province, China were enrolled in this study. All patients received conventional doses of lamivudine and adefovir dipivoxil, telbivudine, entecavir dispersible tablets, or entecavir tablets for 96 wk. Patients who used other antiviral drugs or antitumor and immune regulation therapy were excluded. Patients were stratified into three groups according to their viral DNA load at 24 wk: < 10 IU/mL (group 1), 10-103 IU/mL (group 2), and > 103 IU/mL (group 3). Correlations of 24-wk DNA load with HBeAg negative status and HBeAg seroconversion at 96 wk were analyzed. Receiver operating characteristic curve analysis was used to test the predictive value of the HBV DNA load at 24 wk for long-term response.
The rates of conversion to HBeAg negative status and HBeAg seroconversion rates were 53.7% and 51.9%, respectively, in group 1; 35.21% and 32.39% in group 2; and 6.38% and 6.38% in group 3. The receiver operating characteristic curves for the three subgroups revealed that the lowest DNA load (< 10 IU/mL) was better correlated with response at 96 wk than a higher DNA load (10-103 IU/mL). Nested PCR was used for amplifying and sequencing viral DNA in patients with a viral DNA load > 200 IU/mL at 96 wk; resistance mutations involving different loci were present in 26 patients, and three of these patients had a viral DNA load 10-103 IU/mL at 96 wk.
Hepatitis B viral DNA load at 24 wk of antiviral treatment in patients with chronic hepatitis B is a predictor of the viral load and response rate at 96 wk.
Core tip: Elimination of the hepatitis B surface antigen is the ultimate goal of antiviral therapy; however, this goal is rarely achieved. Complete suppression of hepatitis B virus (HBV) DNA is the current goal of antiviral therapy. Early determination of patients who are not likely to respond to chronic antiviral therapy may help providers make appropriate, timely changes. This study demonstrated a 100% complete DNA response and approximately 50% hepatitis B envelope antigen seroconversion at week 96 when the HBV DNA was suppressed to < 10 IU/mL at week 24. For patients who do not achieve HBV DNA < 10 IU/mL at week 24, add-on or alternative therapies should be considered.