Durability of Hbsag Loss During or After Antiviral Treatment and Impact on Clinical Outcome

Aims: Concerning the durability of HBsAg loss during or after antiviral treatment only a few studies with conflicting results are available indicating a rate of reactivation with reocurrence of HBsAg and/or HBV-DNA in 4.2% 16.4% in predominantly Asian patients. However, there are no larger European studies available concerning the durability of HBsAg loss during or after antiviral treatment and the impact on further clinical outcome. Patients and Methods: In this retrospective German multicentre study, 143 patients with chronic hepatitis B (mean age: 43 ± 13.8 years, 93 males, 50 females) who lost HBsAg during or after antiviral treatment were included. Antiviral treatment with peginterferon-alpha2a (PegIFNalpha2a) and/or nucleus(t)ides were administered between April 2008 and July 2014. Before antiviral treatment, 17 patients had established liver cirrhosis. Primary endpoint was reactivation with reoccurrence of HBsAg Further endpoints were clinical progressive liver disease, liver transplantation and death. Result: During the follow-up period (mean: 3.0 ± 2.1 years) a reoccurrence of HBsAg was observed in only 3/143 patients (2.1%), and in none with previous seroconversion to Anti-HBs. The HBV reactivation in these patients was not associated with detectable HBV-DNA levels, 2/3 patients had baseline cirrhosis and 1/2 subsequently died due to recurrent multifocal hepatocellular carcinoma. Among the 140 patients with persisting HBsAg loss, two initially cirrhotic patients died, and one received liver transplantation all due to hepatocellular carcinoma. Conclusion: In a predominantly Caucasian patient population HBsAg loss during and/or after antiviral treatment seems to be durable with low rates of reactivation. Cirrhotic patients, however, have a high risk developing hepatocellular carcinoma even after HBsAg loss. Continous surveillance in these patients seems to be mandatory.