title: Combination of hepatitis B viral antigens and DNA for prediction of relapse after discontinuation of nucleos(t)ide analogs in patients with chronic hepatitis B.
abstract: OBJECTIVE
  The factors associated with hepatitis recurrence after discontinuation of nucleos(t)ide analogs (NAs) in patients with chronic hepatitis B were analyzed to predict the risk of relapse more accurately.
  
  
  METHODS
  A total of 126 patients who discontinued NA therapy were recruited retrospectively. The clinical conditions of a successful discontinuation were set as alanine aminotransferase (ALT) below 30 IU/L and serum hepatitis B virus (HBV) DNA below 4.0 log copies/mL.
  
  
  RESULTS
  Relapse of hepatitis B were judged to occur when maximal serum ALT became higher than 79 IU/L or when maximal serum HBV DNA surpassed 5.7 log copies/mL following NA discontinuation since these values corresponded with mean values of ALT (30 IU/L) and HBV DNA (4.0 log copies/mL), respectively. At least 90% of patients with either detectable hepatitis B e antigen or serum HBV DNA higher than 3.0 log copies/mL at the time of NA discontinuation relapsed within one year. In the remaining patients, higher levels of both hepatitis B surface and core-related antigens at the time of discontinuation, as well as a shorter course of NA treatment, were significantly associated with relapse by multivariate analysis.
  
  
  CONCLUSIONS
  It appears that negative results for hepatitis B e antigen and serum HBV DNA lower than 3.0 log copies/mL are essential for successful NA discontinuation, which may be attained by a longer treatment period. Levels of hepatitis B surface and core-related antigens are also significant factors independently associated with relapse of hepatitis.
authors: Department of Medicine, Shinshu University School of Medicine, Matsumoto             Department of Hepatology, Toranomon Hospital             Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo             Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences             Gastroenterology Section, Nagoya Daini Red Cross Hospital, Nagoya             Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University             Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo             The Clinical Research Center, NHO Nagasaki Medical Center, Omura             Program for Biomedical Research, Division of Frontier Medical Science, Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima             Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba             Division of Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo College of Medicine, Hyogo             Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Akihiro
authors: A
authors: Matsumoto
authors: Eiji
authors: E
authors: Tanaka
authors: Yoshiyuki
authors: Y
authors: Suzuki
authors: Mariko
authors: M
authors: Kobayashi
authors: Yasuhito
authors: Y
authors: Tanaka
authors: Noboru
authors: N
authors: Shinkai
authors: Shuhei
authors: S
authors: Hige
authors: Hiroshi
authors: H
authors: Yatsuhashi
authors: Shinya
authors: S
authors: Nagaoka
authors: Kazuaki
authors: K
authors: Chayama
authors: Masataka
authors: M
authors: Tsuge
authors: Osamu
authors: O
authors: Yokosuka
authors: Fumio
authors: F
authors: Imazeki
authors: Shuhei
authors: S
authors: Nishiguchi
authors: Masaki
authors: M
authors: Saito
authors: Kei
authors: K
authors: Fujiwara
authors: Nobuyuki
authors: N
authors: Torii
authors: Naoki
authors: N
authors: Hiramatsu
authors: Yoshiyasu
authors: Y
authors: Karino
authors: Hiromitsu
authors: H
authors: Kumada