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Low Incidence of HBeag Seroconversion with nucs in Routine Practice

http://archive.mail-list.com/hbv_research/message/20130116.233638.54354562.en.html
Source

Pacific Health Foundation, San Jose, CA, USA.

Abstract

BACKGROUND/AIM:

Treatment endpoint of therapy for patients with hepatitis B e
antigen-positive (HBeAg) chronic hepatitis B (CHB) includes HBeAg
seroconversion, which ranges 15-22% after 1 year of oral nucleos(t)ides
according to clinical trials. Our goal was to determine the incidence
and predictors of HBeAg seroconversion in such patients in routine
clinical practice, since it may differ than reported rates.

METHODS:

We conducted a retrospective cohort study of 333 consecutive
treatment-naïve HBeAg-positive patients who were treated for CHB between
1/2000 and 6/2010 at 3 gastroenterology and liver clinics in the United
States. Primary study endpoint was HBeAg seroconversion - loss of HBeAg
and antibody to HBeAg (anti-HBe) development.

RESULTS:

The majority of patients were Asian (96%). Median treatment duration
prior to HBeAg seroconversion was 50 (range, 26-52) weeks. Of the 333
study patients, 25% received lamivudine (LAM), 16% adefovir (ADV), 51%
entecavir (ETV) and 8% tenofovir (TDF). HBeAg seroconversion at month 12
was 8.2%. On multivariate analysis inclusive of age, gender and
antiviral agents, independent predictors for HBeAg seroconversion at
month 12 were HBV DNA  1.5 × upper normal limit (HR=2.86 [1.05-7.81], p=0.040), but
not the choice of nucleos(t)ides.

CONCLUSIONS:

The HBeAg seroconversion rate seen in clinical settings for oral
nucleos(t)ides appears much lower than those reported in pivotal trials,
especially in those with lower ALT and higher HBV DNA levels.
HBeAg-positive patients should be counseled about the high possibility
of the long treatment duration required to achieve recommended treatment
endpoints.
22 Responses
Avatar universal
the intf combo or staggered strategy is a must here
Avatar universal
Stef ..

Iam under antiviral (baraclude .5 mg) ..
iam male 39 y .. hep b carrier ..

if the pcr is undectable and the alt is aound 30 .. sometimes 26 up to 33 ..

do these two indications (pcr "hbvdna" and alt) mean 100% guarantee .. and the liver will be protected from fibrosis, cirrohisis and hcc?

my close relative he is in last stage of cirrohsis ..also  he has ascite .. his abdomen is very big  .. he knew he has cronic  heb b 2 years ago .. now he is 52 y .. in spite he started baraclude .5 mg since he knew the infection.. now he is 3 days in Hepatic encephalopathy .. he is in coma ..

as i undderstood from doctors in the emergency department .. the ammonia in his blood is more than 130 ..
now we are thinking to implant liver .. what is your suggestion?


Avatar universal
????????

any feedback?
Avatar universal

that's too advanced stage for liver transplant too, refer to the doctos at the hospital and try to contact hepatitistechnologies to know if they have data and experience of heptech at that late stage

the antiviral with hbvdna und and normal alt is a must but recovery from such stage is very very difficult.
just check that the antiviral is entecavir (baraclude) but no previous exposure to lam, if there was exposure to lam it is best to add on tenofovir when stable (no switch), a resistance to antiviral at cirrhosis stage can be deadly
Avatar universal

do these two indications (pcr "hbvdna" and alt) mean 100% guarantee .. and the liver will be protected from fibrosis, cirrohisis and hcc?

no, just lowered risk to very low if proper diet and adding sim

i hope transplant is still possible
Avatar universal
Very sorry to hear about your relative. The prognosis is not good, especially with hepatic coma. Still, he is only 52, he may pull through.
I just want to ask - how long had he been on Entecavir before he was hospitalized?

My best wishes.
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