Relapse in patients with chronic hepatitis B infection treated with oral antivirals (nucleotide / nucleoside), after treatment discontinuation

Yemisen M., Yildiz S., Balkan I. I. , METE B. , ÖZARAS R. , SALTOĞLU N. , ...More

Infectious Disease Week 2014, Philadelphia, United States Of America, 8 - 12 October 2014, vol.1, no.1, pp.1177

  • Publication Type: Conference Paper / Full Text
  • Volume: 1
  • City: Philadelphia
  • Country: United States Of America
  • Page Numbers: pp.1177


Background: The aims of treatment in chronic hepatitis B (CHB) are suppression of HBV replication and the prevention of liver diseases. Nucleoside (nucleotide) analogues (NA) are oral antiviral drugs used for treatment of chronic HBV infection. Therewithal, they cause regression in liver fibrosis and allow histological healing. The duration of treatment with oral antiviral drugs is still unclear. In this study, we investigated the frequency of relapse in patients with CHB after cessation NA.

Methods: Chronic hepatitis B (HBeAg negative or positive) patients whose NA treatments were discontinued for any reason were included to the study. Relapse was accepted as the HBV viral load over 2000 IU/ml or ALT levels two fold higher than the normal level in patients whose HBV DNA levels were undetectable or ALT levels were in normal ranges for the last three outpatient follow-up during the cessation of NA oral antivirals. In patients whose HBV DNA level was detectable but suppressed during the cessation of NA oral antivirals, increase of HBV DNA level to pretreatment levels was accepted as relapse. 

Results: Thirty eight patients were included to our study whose NA treatments were discontinued for any reason. Fifteen patients used tenofovir, 14 used entecavir, 7 used lamivudin, and 2 used adefovir. During the cessation of drugs, HBV DNA levels were undetectable in 30 patients; while 8 patients had detectable HBV DNA levels. Before the treatment, the numbers of patients with HBeAg positive and negtaive were 21 (55.3%) and 17 (44.7%), respectively. The reasons for cessation of NA drugs in patients were as follows; in 17 patients with his own request, in 16 patients with doctor’s request, in 4 patients because of pregnancy and in one patient because of HBsAg seroconversion. In patients who discontinued treatment with undetectable HBV DNA relapse was observed in 23 of 30 patients and in 7 of 8 patients with detectable HBV DNA, viral load increased to pretreatment levels after cessation of NA drugs. Fulminant hepatitis was not obsereved in any of the patients with relapses.

Conclusion: In patients using oral antiviral treatment, cessation of NA oral antivirals was found to be associated with high virologic relapses.