Hepatitis B e Antigen Seroconversion: A Critical Event in Chronic Hepatitis B Virus Infection

March 22, 2010

Dig Dis Sci. 2010 Mar 18. [Epub ahead of print]

Hepatitis B e Antigen Seroconversion: A Critical Event in Chronic Hepatitis B

Virus Infection.

Liaw YF, Lau GK, Kao JH, Gane E.

Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University

College of Medicine, 199 Tung Hwa North Road, Taipei, 105, Taiwan,

liveryfl@....

BACKGROUND: Replication of hepatitis B virus (HBV) is the primary driver of

disease progression and clinical outcomes in patients with chronic hepatitis B

(CHB), but other factors, such as hepatitis B e antigen (HBeAg) status, also

influence disease course. The importance of HBeAg seroconversion is underscored

by current CHB treatment guidelines that recommend limiting the duration of

antiviral therapy in HBeAg-positive patients who achieve seroconversion. AIMS: A

2-day meeting of leading hepatologists with extensive experience managing

patients with CHB in the Asia-Pacific region was held with the overall goals of

reviewing and evaluating (1) available data on the relationship between HBeAg

seroconversion and clinical outcomes for patients with HBeAg-positive CHB, and

(2) the ways in which seroconversion should influence patient management.

CONCLUSIONS: It was agreed that HBeAg seroconversion is an important serologic

end point for patients with CHB and that achieving this goal should be an

important consideration in treatment selection. Patients with HBeAg-positive CHB

should consider pegylated interferon if they are aged <40 years (especially

women), have lower HBV DNA levels, can afford this treatment, and have a

lifestyle that would support adherence to injection therapy. Alternatively,

nucleos(t)ide analogs are recommended in patients with alanine aminotransferase

levels>/=2 x the upper limit of normal, HBV DNA levels <9 log(10) IU/ml, and

compensated CHB. Entecavir, telbivudine, and tenofovir may be used as first-line

therapy; they can be administered as a finite therapeutic course in

HBeAg-positive patients who seroconvert. Telbivudine and tenofovir should be

considered in women of child-bearing potential.

PMID: 20238245 [PubMed - as supplied by publisher]

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