Long term follow up of chronic hepatitis B patients after oral antiviral treatment discontinuation

초록

Introduction: In the current guidelines, 6-12 months of consolidation after the HBeAg seroconversion is recommended for HBeAg-positive patients. And the ideal treatment duration of HBeAg negative chronic hepatitis B (CHB) is not well known. We evaluated long term clinical courses in patient after antiviral treatment cessation. Methods: A total of 118 HBeAg-positive and 60 HBeAg-negative CHB patients who discontinued lamivudine between 1997 and 2014 were retrospectively analyzed. Results: In HBeAg-positive patients, the mean age of the patients at treatment initiation was 32.5 years. The mean duration of lamivudine treatment in was 32.3 months and the mean follow-up period after discontinuation was 72.4 months. The cumulative probability of a composite relapse (≥ 104 copies/ mL) at 1, 6, 12, 24, 48, 96, 180 months were 11.9%, 28.8%, 38.1%, 51.7%, 59.3%, 63.6%, 64.4% respectively. The mean duration of lamivudine treatment were 31.9 months and 32.9 months in the relapse and non-relapse group (p = 0.79). The mean duration of consolidation period after HBeAg seroconversion were 10.7 months and 11.4 months were not different (p = 0.792). Multivariate analysis revealed pretreatment age ≤ 34 years [HR 0.324, 95% CI: 0.148-0.710 p = 0.005] and undetectable HBV DNA [HR 0.261, 95% CI: 0.107-0.638 p = 0.003] within the three month after treatment discontinuation were the predictive factors of non-relapse. In HBeAg-negative patients, the mean age of the patients was 39.2 years. The cumulative probability of a composite relapse at 1, 6, 12, 24, 48, 96, 180 months were 25.0%, 33.3%, 35.0%, 41.7%, 43.3%, 46.7%, 48.3% respectively. Mean time to relapse after off-treatment was 13.6 months. The mean duration of lamivudine treatment were 29.8 months and 33.5 months in the relapse and non-relapse group (p = 0.447). Conclusions: Even with the long term consolidation after HBeAg seroconversion, most HBeAg positive CHB patients showed relapse. And half of patients with HBeAg-negative CHB had relapsed after treatment cessation. Antiviral therapy should be maintained for long term period or until HBsAg was lose.