title: High frequency of recurrent viremia after hepatitis B e antigen seroconversion and consolidation therapy.
abstract: BACKGROUND
  The primary treatment endpoint for hepatitis B e antigen (HBeAg)-positive chronic hepatitis B is HBeAg seroconversion; however, data on the durability of response are inconsistent.
  
  
  OBJECTIVE
  Our goal was to investigate the rate of recurrent viremia after HBeAg seroconversion and subsequent discontinuation of therapy.
  
  
  METHODS
  We retrospectively studied 88 consecutive Asian American patients who achieved HBeAg seroconversion [loss of HBeAg and development of antibody to HBeAg (anti-HBe)] among 458 HBeAg-positive patients who received oral antiviral therapy at 3 US clinics between March 1998 and November 2010. Recurrent viremia was defined as reappearance of detectable serum hepatitis B virus DNA (>100 IU/mL) on 2 consecutive laboratory tests from previously undetectable levels.
  
  
  RESULTS
  Antiviral medications used at the time of HBeAg seroconversion included: lamivudine (23%), adefovir (34%), entecavir (36%), tenofovir (4%), and combination therapy (3%). Antiviral therapy was continued after HBeAg seroconversion in 49 patients (group I) and discontinued in the other 39 patients after consolidation therapy [median=12 months (range, 1 to 55 mo)] (group II). No patients in group I experienced recurrent viremia, whereas 90% in group II did. Elevated alanine aminotransferase also occurred in 38% of group II patients [median peak alanine aminotransferase 249 IU/mL (range, 93 to 1070 IU/mL)].
  
  
  CONCLUSIONS
  Despite consolidation therapy, almost all patients who discontinued therapy after achieving HBeAg seroconversion and complete viral suppression experienced recurrent viremia, and close to half also experienced biochemical flares. HBeAg seroconversion does not seem to be a durable treatment endpoint for many patients, and they should be monitored carefully for virologic relapse and biochemical flares if antiviral therapy is withdrawn.
authors.affiliation: Pacific Health Foundation, San Jose, CA, USA.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Chaung
authors.forename: Nghiem B
authors.initials: NB
authors.lastname: Ha
authors.forename: Huy N
authors.initials: HN
authors.lastname: Trinh
authors.forename: Ruel T
authors.initials: RT
authors.lastname: Garcia
authors.forename: Huy A
authors.initials: HA
authors.lastname: Nguyen
authors.forename: Khanh K
authors.initials: KK
authors.lastname: Nguyen
authors.forename: Gabriel
authors.initials: G
authors.lastname: Garcia
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
authors.forename: Emmet B
authors.initials: EB
authors.lastname: Keeffe
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use*; D060830:Consolidation Chemotherapy; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000188:drug therapy* / Q000276:immunology*; D006513:Hepatitis B e Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014766:Viremia / Q000097:blood*
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase