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Role of hepatitis B surface antigen in hepatitis B virus relapse after entecavir or tenofovir prophylaxis in patients undergoing cancer chemotherapy
Author(s) -
Kuo MingTe,
Tseng PoLin,
Chou YehPin,
Chang KuoChin,
Tsai MingChao,
Kuo YuanHung,
Hu TsungHui,
Hung ChaoHung,
Wang JingHoung,
Lu ShengNan,
Chen ChienHung
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14142
Subject(s) - medicine , entecavir , hbsag , gastroenterology , hepatitis b virus , hepatitis b , chemotherapy , hbeag , hepatitis , immunology , virus , lamivudine
Background and Aim This study investigated whether hepatitis B surface antigen (HBsAg) could predict hepatitis B virus (HBV) relapse after cessation of entecavir or tenofovir disoproxil fumarate (TDF) prophylaxis for chronic hepatitis B cancer patients who are undergoing chemotherapy. Methods The study enrolled 122 hepatitis B e‐antigen‐negative cancer patients who underwent chemotherapy with entecavir or TDF for antiviral prophylaxis and posttreatment follow‐up for at least 6 months. Results Of the 122 patients, 52 and 18 experienced virological and clinical relapse, which had 3‐year cumulative incidences of 46.6% and 18.6%, respectively. Multivariate analysis showed that end‐of‐treatment HBsAg levels and baseline HBV‐DNA ≥ 2000 IU/mL were independent predictors of virological relapse. The best HBsAg cutoff value was 500 IU/mL. An end‐of‐treatment HBsAg of 500 IU/mL was useful for predicting virological relapse in patients with baseline HBV‐DNA < 2000 IU/mL (3‐year rate: 21.3% vs 46.4%, P = 0.038, in patients with HBsAg < 500 and ≥ 500 IU/mL, respectively), but not in patients with baseline HBV‐DNA ≥ 2000 IU/mL. Of the 52 patients who experienced virological relapse, 13 experienced transient virological relapse. Patients with baseline HBV‐DNA level < 2000 IU/mL experienced a higher rate of transient virological relapse (42.1% vs 15.2%, P = 0.031). Three patients experienced hepatic decompensation upon alanine aminotransferase flares, and no patient died after timely retreatment. Ten patients experienced posttreatment HBsAg loss, and the 3‐year HBsAg loss rate was 30.7% in patients with end‐of‐treatment HBsAg < 100 IU/mL. Conclusions The baseline HBV‐DNA and end‐of‐treatment HBsAg levels could predict virological relapse after withdrawal of entecavir and TDF prophylaxis for chemotherapy.