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- Title
Time-varying serum gradient of hepatitis B surface antigen predicts risk of relapses after off-NA therapy.
- Authors
Nai-Hsuan Chien; Yen-Tsung Huang; Chun-Ying Wu; Chi-Yang Chang; Ming-Shiang Wu; Jia-Horng Kao; Lein-Ray Mo; Chi-Ming Tai; Chih-Wen Lin; Tzeng-Huey Yang; Jaw-Town Lin; Yao-Chun Hsu; Chien, Nai-Hsuan; Huang, Yen-Tsung; Wu, Chun-Ying; Chang, Chi-Yang; Wu, Ming-Shiang; Kao, Jia-Horng; Mo, Lein-Ray; Tai, Chi-Ming
- Abstract
<bold>Background: </bold>The serum gradient of hepatitis B surface antigen (HBsAg) varies over time after cessation of nucleos(t)ide analog (NA) treatment in patients with chronic hepatitis B (CHB). The association between the time-varying HBsAg serum gradient and risk of relapse has not been elucidated.<bold>Methods: </bold>This multicenter cohort study prospectively enrolled CHB patients who discontinued 3 year-NA treatment. Eligible patients were serologically negative for HBeAg and viral DNA at NA cessation. The participants (n = 140) were followed every 3 months through HBsAg quantification. Virological and clinical relapses were defined as viral DNA levels >2000 IU/mL and alanine aminotransferase (ALT) levels >80 U/mL, respectively. The association of time-varying HBsAg levels with relapses was assessed through a time-dependent Cox analysis.<bold>Results: </bold>During a median follow-up of 19.9 (interquartile range [IQR], 10.6-25.3) months, virological and clinical relapses occurred in 94 and 49 patients, with a 2-year cumulative incidence of 79.2% (95% confidence interval [CI], 70.9%-86.4%) and 42.9% (95% CI, 34.1%-52.8%), respectively. The serum level of HBsAg was associated with virological (P < 0.001) and clinical (P = 0.01) relapses in a dose-response manner, with adjusted hazard ratios of 2.10 (95% CI, 1.45-3.04) and 2.32 (95% CI, 1.28-4.21). Among the patients (n = 19) whose HBsAg levels ever dropped below 10 IU/mL, only one and three patients subsequently developed clinical and virological relapses.<bold>Conclusion: </bold>The serum gradient of HBsAg measured throughout the off-therapy observation is associated with the subsequent occurrence of virological and clinical relapses in CHB patients who discontinue NA treatment.
- Subjects
HEPATITIS associated antigen; HEPATITIS B; HEPATITIS B treatment; PROPORTIONAL hazards models; DNA; PATIENTS
- Publication
BMC Gastroenterology, 2017, Vol 17, p1
- ISSN
1471-230X
- Publication type
journal article
- DOI
10.1186/s12876-017-0697-3