Hepatitis B virus (HBV) rebounded in nearly 80% of people treated with fully or partially suppressive antiviral therapy using adefovir (Hepsera), entecavir (Baraclude), lamivudine (Epivir), or tenofovir (Viread), indicating that long-term therapy is usually needed to control the virus, researchers reported at IDWeek 2014 last month in Philadelphia.
Hepatitis B may be treated with a number of approved nucleoside/nucleotide analog antiviral drugs. While these are initially quite effective at suppressing HBV, some are prone to resistance -- leading to viral breakthrough during therapy -- or the virus may rebound after treatment is stopped. Maintaining viral suppression can lead to normalization of liver enzymes associated with inflammation and reduce the risk of progressing to cirrhosis or liver cancer.Fehmi Tabak from Istanbul University and colleagues looked at the frequency of relapse among chronic hepatitis B patients after discontinuing nucleoside/nucleotide analogs for any reason.
This analysis included 38 participants in Turkey. Most (76%) were men and the mean age was 41 years. At baseline, 55% were hepatitis B "e" antigen (HBeAg) positive while 45% were HBeAg negative.
The most commonly used antivirals were tenofovir and entecavir (40% and 37%, respectively), followed by lamivudine (18%) and adefovir (5%). Reasons for treatment discontinuation included patient choice (45%), doctor's judgment (42%), pregnancy (10%), and hepatitis B surface antigen (HBsAg) seroconversion.
For people who achieved undetectable HBV viral load while on treatment, relapse was defined as HBV DNA viral load >2000 IU/mL and/or an alanine aminotransferase (ALT) level 2-fold higher than the upper limit of normal. For people whose viral load was reduced but detectable at the time of treatment discontinuation, it was defined as HBV DNA returning to pre-treatment levels.
- At the time of treatment discontinuation, 30 people had undetectable HBV DNA, while the remaining 8 had detectable levels.
- Among patients who discontinued treatment with undetectable HBV DNA, 23 out of 30 (77%) experienced viral relapse.
- Among those with detectable HBV DNA at the time of discontinuation, 7 of 8 (88%) relapsed.
- Relapse occurred in patients taking each of the 4 antiviral drugs, though it appeared somewhat less likely with tenofovir compared with entecavir.
- Fulminant hepatitis -- or a sudden worsening of liver function -- was not observed in any of the patients who relapsed.
In patients using oral antiviral treatment, cessation of nucleoside/nucleotide analog oral antivirals was found to be associated with a high rate of virological relapse, the researchers concluded.
These findings confirm data from other studies suggesting that most people treated for chronic hepatitis B may need to remain on antiviral therapy indefinitely to achieve the benefits of viral control.
M Yemisen, SYKaya, I Balkan, F Tabak, et al. Relapse in Patients with Chronic Hepatitis C Infection Treated with Oral Antivirals (Nucleotide/Nucleoside), after Treatment Discontinuation. IDWeek 2014. Philadelphia, October 8-12, 2014. Abstract 1177.