Long-term follow-up of treatment-naive HBeAg-negative patients with chronic hepatitis B

Background/aims We aimed to explore long-term results of oral antiviral agents in treatment-naive HBeAg negative chronic hepatitis B (CHB) and determine the factors affecting the complete virological response. Method Patients with HBeAg-negative CHB who used oral antiviral agents for at least 3 years were evaluated retrospectively. Results A total of 173 patients were recorded. The mean duration of treatment was 62.2 +/- 28.9 months. Complete virological responses (CVR) were 82.8% (n = 53/64) in tenofovir disoproxil fumarate (TDF), 84.4% (n = 49/58) in lamivudine (LAM), 83.9% (n = 26/31) in entecavir (ETV), 95% in telbivudine (LdT) (n = 19/20) (p = 0.290). Multivariate analysis revealed age <= 40 (p = 0.012, 95%CI = 1.38-13.76, OR = 4.36) and baseline HBV DNA value (p = 0.003, 95%CI = 1.23-2.63, OR = 1.78) as independent factors for CVR. Virological breakthrough was detected in 29 (50%) patients on LAM therapy, two (6.4%) patients on ETV therapy, and two (10%) patients on LdT therapy. Treatment was switched to another antiviral agent due to osteoporosis in four patients in the TDF group, muscle pain in nine patients in the LDT group, and headache in one patient in the ETV group. Hepatocelluler cancer was detected in five patients. HBsAg seroclearance developed in two patients. Anti-HBs seroconversion was not detected. Conclusion CVR was achieved at similar rates with all four antiviral agents, while younger age (<= 40) and low baseline viral load were the main factors for virological response. However, drug resistance and virological breakthrough in the LAM group and side effects in the LdT group were detected during the long-term follow-up. Moreover, HBsAg seroclearance was achieved at very low rates with oral antiviral agents.

Automated summary

Oral antiviral agents can achieve similar complete virological responses in the treatment of HBeAg-negative chronic hepatitis B. Younger age and low baseline viral load are the main factors for virological response. However, drug resistance and virological breakthrough in the lamivudine group, as well as side effects in the telbivudine group, were observed during long-term follow-up. The effectiveness of oral antiviral agents in achieving HBsAg seroclearance is low.