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Clinical characteristics and outcomes of patients with recurrent chronic hepatitis B after nucleos(t)ide analog withdrawal with stringent cessation criteria: A prospective cohort study
Author(s) -
Liu Zhirong,
Liu Feng,
Wang Lei,
Liu Youde,
Zhang Meng,
Li Tao
Publication year - 2017
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12836
Subject(s) - medicine , hbeag , gastroenterology , hepatitis b , hepatitis b virus , chronic hepatitis , prospective cohort study , hbsag , immunology , virus
Aim The aim of this study was to explore the clinical characteristics and outcomes of patients with recurrent chronic hepatitis B meeting the cessation criteria outlined by the 2008 Asian Pacific Association for the Study of the Liver guidelines. Methods In total, 223 chronic hepatitis B patients who met the cessation criteria and discontinued nucleos(t)ide analog therapy were prospectively included. They were monitored monthly during the first 4 months and every 3–6 months thereafter. Early relapse was defined as viral relapse (serum hepatitis B virus [HBV] DNA >10 4 copies/mL) confirmed within 3 months after cessation. Results Of the 38 hepatitis B e antigen (HBeAg)‐positive relapse cases, 44.7%, 65.8%, 76.3% and 89.5% occurred within 3 months, 6 months, 12 months, and 48 months, respectively; in the 49 HBeAg‐negative relapse cases, 44.9%, 51.0%, 77.6% and 91.8% occurred within 3, 6, 12 and 36 months, respectively. Time to undetectable HBV DNA was a predictive factor of early relapse. Viral relapses were accompanied by elevated alanine aminotransferase in 70 (80.5%) patients. A peak alanine aminotransferase 10 times over the upper limit of normal after relapse was observed in 15.8% of the HBeAg‐positive and 22.4% of the HBeAg‐negative patients. Hepatic decompensation and liver failure were not observed. Conclusions For HBeAg‐positive and HBeAg‐negative patients meeting stringent cessation criteria, at least 4 years and 3 years of close follow‐up are necessary. For those with a longer time to undetectable HBV DNA, more attention should be paid to the early stages after cessation. Nucleos(t)ide analog withdrawal in selected non‐cirrhotic patients is generally safe, although close monitoring and timely intervention are needed.