HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:
- Patients Who Clear Hepatitis B During Antiviral Treatment Do Well Long-Term
- However, the Prognosis is Poor for Most Who Stop Antiviral Treatment
- How Effective Are Antivirals in Reducing Cirrhosis and Preventing Liver Cancer?
- New Antiviral Besifovir Hampered by Carnitine Deficiency in Early Clinical Trial
- Liver Cancer Remains Major Health Threat, with Few Treatment Options
- Scientists Develop a Better Mouse for Hepatitis B and C Research
- HBV-Infected People Have a Higher Risk of Rheumatoid Arthritis
- Ear Wax May Transmit Hepatitis B
- Children with Frequent Ear Infections Do Not Respond as Well to Vaccines
- Clean-Shave Haircuts Leave Traces of Virus on the Scalp
HBV Journal Review
November 1, 2013
Vol 10, no 11
by Christine M. Kukka
Patients Who Clear Hepatitis B During Antiviral Treatment Do Well Long-Term Patients who respond well to antiviral treatment and clear the hepatitis B surface antigen (HBsAg) during treatment generally do well in the years after treatment stops, according to a report published in the October 2013 issue of the journal Gut.
Korean researchers monitored patients who cleared HBsAg during antiviral treatment with either lamivudine (Epivir-HBV) or entecavir (Baraclude) for nearly six years after treatment stopped. Antiviral drugs work by interfering with HBV’s biochemistry to stop them from replicating. In this study, a very small percentage–about 0.33% of the 5,409 patients–cleared HBsAg each year.
Patients who were most likely to lose HBsAg had highly-elevated alanine aminotransferase (ALT) levels when they started treatment–indicating their immune systems were already attacking the HBV-infected liver cells. ALT levels rise when liver cells are damaged or die.
In contrast, patients who had high viral loads with lots of virus circulating in their bodies and were hepatitis B “e” antigen (HBeAg)-positive were least likely to clear HBsAg during treatment.
Patients with cirrhosis (severe liver scarring) rarely cleared the virus; however, the fortunate few cirrhotic patients who lost HBsAg had much lower rates of liver cancer than cirrhotics who failed to clear HBsAg.
A return of HBsAg and a small increase in HBV DNA occurred in 18 patients who had initially cleared HBsAg. However, their HBsAg and viral load levels remained low and none required a second round of antiviral treatment.
Four years after clearing HBsAg, 67.4% of the patients developed surface antibodies, indicating they had successfully cleared the infection.
“HBsAg seroclearance achieved after (antiviral) treatment was associated with favorable clinical outcomes and was durable in most cases during long-term follow-up,” researchers concluded.
However, the Prognosis is Poor for Most Who Stop Antiviral Treatment No one wants to be treated with antivirals for numerous years, so when is it safe to stop treatment? To date, most HBeAg-negative patients relapse and have a rebound in their viral load after they stop taking antivirals.
South Korean followed 45 HBeAg-negative patients who had undetectable viral when they stopped taking antivirals. They found that within 12 months of stopping treatment, a climb in viral load exceeding 2,000 international units per milliliter (IU/mL) occurred in 73.3% of patients and both elevated viral load and ALT levels–signaling liver damage–occurred in 53.5% of patients, researchers reported in the September issue of the journal of Clinical and Molecular Hepatology.