title: Durability of Hepatitis B e Antigen Seroconversion in Chronic Hepatitis B Patients Treated with Entecavir or Tenofovir.
abstract: BACKGROUND
  Loss of HBeAg and development of anti-HBe (seroconversion) is seen as a milestone and endpoint in the treatment of HBeAg-positive patients with chronic hepatitis B (CHB). Among patients treated with nucleos(t)ide analogs (NA), recurrent viremia is common after discontinuation of therapy. Entecavir (ETV) and tenofovir (TDF) are highly potent NA. The durability of virological response and HBeAg seroconversion in patients treated with these agents is not well studied.
  
  
  METHODS
  We retrospectively studied the outcomes of 54 HBeAg-positive CHB patients who were treated with either ETV (n = 30) or TDF (23) or both (n = 1) that achieved virological response and underwent seroconversion and consolidation therapy before cessation of treatment.
  
  
  RESULTS
  Only 4 (7%) patients had sustained virological, serological, and biochemical remission. Thirteen patients (24%) continued to have HBV DNA levels below 2000 IU/mL and normal alanine aminotransferase activity (ALT). Thirty-seven patients (69%) developed HBV DNA >2000 IU/mL, with 20 having elevated ALT. Among these 37 patients, 23 (62%) remained HBeAg negative/anti-HBe positive, 12 (32%) became HBeAg positive, and 2 (5%) were HBeAg and anti-HBe negative. Duration of consolidation therapy did not correlate with low versus high level of virological relapse.
  
  
  CONCLUSIONS
  Durability of HBeAg seroconversion associated with ETV or TDF was not superior to that reported in patients treated with less potent NA. Our results, aggregated with others, suggest HBeAg seroconversion should not be considered as a treatment endpoint for most HBeAg-positive patients treated with NA. Future updates of treatment guidelines should reconsider HBeAg seroconversion as an endpoint to therapy.
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA. tselingf@usc.edu.|Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, 2/F, Los Angeles, CA, 90033, USA. tselingf@usc.edu.
authors.forename: Tse-Ling
authors.initials: TL
authors.lastname: Fong
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Tien
authors.affiliation: Liver Disease and Transplant Program, California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Kahee J
authors.initials: KJ
authors.lastname: Jo
authors.affiliation: Private Practice, New York, NY, USA.
authors.forename: Danny
authors.initials: D
authors.lastname: Chu
authors.affiliation: Division of Gastroenterology, University of California Davis, Davis, CA, USA.|Private Practice, Oakland, CA, USA.
authors.forename: Eddie
authors.initials: E
authors.lastname: Cheung
authors.affiliation: Liver Center, Huntington Research Institute, Pasadena, CA, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Mena
authors.affiliation: Private Practice, Fountain Valley, CA, USA.
authors.forename: Quang-Quoc
authors.initials: QQ
authors.lastname: Phan
authors.affiliation: Private Practice, San Jose, CA, USA.
authors.forename: Andy S
authors.initials: AS
authors.lastname: Yu
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
authors.forename: Wafa
authors.initials: W
authors.lastname: Mohammed
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Velasco
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
authors.forename: Vinh-Huy
authors.initials: VH
authors.lastname: LeDuc
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
authors.forename: Nickolas
authors.initials: N
authors.lastname: Nguyen
authors.affiliation: Division of Gastroenterology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Steven-Bui
authors.initials: SB
authors.lastname: Han
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
authors.forename: Mimi
authors.initials: M
authors.lastname: Chang
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
authors.forename: Ho S
authors.initials: HS
authors.lastname: Bae
authors.affiliation: Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
authors.forename: Yong-Won
authors.initials: YW
authors.lastname: Cho
authors.affiliation: Liver Center, Huntington Research Institute, Pasadena, CA, USA.
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Tong
authors.affiliation: Liver Disease and Transplant Program, California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Stewart L
authors.initials: SL
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D000068698:Tenofovir / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir
keywords: Relapse; Remission; Seroreversion