title: Study on Post-Treatment Relapse in HBeAg Positive CHB Patients.
abstract: BACKGROUND
  Many factors are associated with post-treatment relapse in CHB patients, and there are no effective factors to predict relapse. In this study, we investigate the influence factors associated with post-treatment relapse and their predictive value in HBeAg positive CHB (eP-CHB).
  
  
  METHODS
  The factors associated with post-treatment relapse were analyzed firstly by a retrospective study in eP-CHB. Variables included age, sex, regimen, baseline HBeAg and HBV DNA level, total course of treatment as well as duration of consolidation therapy after HBeAg seroconversion. The predictive effects of the influence factors were evaluated in an eP-CHB prospective cohort.
  
  
  RESULTS
  89 patients were enrolled in the retrospective study, 42(47.2%) relapsed after discontinuation of treatment. Factors related to post-treatment relapse were total course of treatment, duration of consolidation therapy and baseline HBV DNA level. Relapse rates in patients with total course >36 months, consolidation duration >12 months and baseline HBV DNA level < 1.0E+5IU/ml were lower than those of total course <24 months (P = 0.002), consolidation duration≤12 months (P = 0.011) and baseline HBV DNA level > 1.0E+7IU/ml (P = 0.01) respectively. Patients with HBV DNA≥1.0E+7IU/ml plus HBeAg<200COI at baseline had the highest relapse rate and cumulative relapse rate than the other three arms (P = 0.048 and 0.008 respectively). Logistic regression analysis demonstrated that baseline HBV DNA level, duration of consolidation therapy and combination of baseline HBV DNA and HBeAg (IgDNA/IgHBeAg) were independent factors to predict post-treatment relapse. The model based on baseline IgDNA/IgHBeAg and consolidation duration worked well in predicting post-treatment relapse in the prospective study and the accuracy, specificity, sensitivity, PPV and NPV for prediction were 80.3%, 81.1%, 79.2%, 73.1% and 85.7% respectively.
  
  
  CONCLUSIONS
  Virological factors including baseline HBV DNA, HBeAg and treatment course were major influence factors associated with post-treatment relapse in eP-CHB. Patients with higher HBV DNA and lower HBeAg levels at baseline, shorter total course as well as consolidation therapy were more likely to develop relapse after discontinuation of therapy. The antiviral therapy in eP-CHB patients should be individually managed at different levels. It is better to treat those with higher viral load and lower HBeAg levels at baseline for a longer course, especially longer consolidation duration so as to decrease the relapse rate.
authors.affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Lu
authors.affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.
authors.forename: Jin'e
authors.initials: J
authors.lastname: Li
authors.affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.
authors.forename: Yali
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Ren
authors.affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhenhuan
authors.initials: Z
authors.lastname: Cao
authors.affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.
authors.forename: Lina
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, United States of America.
authors.forename: Chengli
authors.initials: C
authors.lastname: Shen
authors.affiliation: Beijing You'an Hospital, Capital Medical University, Beijing, China.
authors.forename: Xinyue
authors.initials: X
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000032:analysis / Q000187:drug effects; D005260:Female; D006513:Hepatitis B e Antigens / Q000378:metabolism*; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens