Clinical observation of condition changes following medication withdraw of nucleoside/nucleotide analogues in patients with chronic hepatitis B / 中华临床感染病杂志

ABSTRACT

Objective To observe the condition changes in patients with chronic hepatitis B (CHB) following medication withdraw of nucleoside/nucleotide analogues (NAs) treatment and to analyze the factors related to disease relapse.Methods Eighty-five CHB patients who discontinued medication of nucleoside/nucleotide analogues for antiviral therapy in Nanjing Second Municipal Hospital from January 2002 to December 2017 were enrolled in the study, among whom 22 cases met the withdrawal criteria (standard withdrawal group ) and 63 cases did not meet the withdraw criteria ( non-standard withdrawal group).The correlation of condition changes (abnormal liver function, positive rate of HBV DNA, hepatic failure with the drug withdrawal , the course of medication, serological transformation of HBeAg during drug withdrawal, HBsAg level, and liver cirrhosis during drug administration was analyzed.Results In standard withdraw group, the medication lasted for ＞3 years, only 1 case had HBV DNA positive conversion , abnormal ALT and TBil, and liver failure.In non-standard withdraw group, 50 cases (79.4%) had HBV DNA positive conversion, 36 (57.1%) had abnormal ALT, 25 ( 39.7%) had abnormal TBil and 14 (22.2%) had liver failure.There were 19 cases with HBsAg ＞1 000 IU/mL and 3 cases with HBsAg ≤1 000 IU/mL, and 1 case with HBsAg＞1 000 IU/mL (5.3%) had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.In non-standard withdraw group, there were 52 cases with HBsAg ＞1000 IU/mL, among whom 45 cases (86.5%) had positive HBV DNA conversion , 31 (59.6%) had ALT abnormalities, 25 (48.1%) had TBil abnormalities, and 13 (25.0%) had liver failure; there were 11 patients with HBsAg ≤1 000 IU/mL, among whom 6 cases (54.5%) had HBV DNA positive conversion , 5 (45.4%) had ALT abnormalities, and no TBil abnormalities or liver failure occurred.There were 5 cases of liver cirrhosis in the standard withdraw group , only 1 case had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.None of the 17 patients with non-cirrhosis had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.There were 29 patients with liver cirrhosis in non-standard withdraw group showed positive HBV DNA conversion , 28 (96.6%) had ALT abnormalities, 22 (75.8%) had TBil abnormalities, and 11 (37.9%) had liver failure; among 34 non-cirrhosis patients, 21 (61.8%) had positive HBV DNA conversion, 8 (23.5%) had ALT abnormalities, 3 (8.8%) had TBil abnormalities, and 2 (5.9%) had liver failure.According to the standard discontinuation , 12 patients (16.7%) had positive HBV DNA transformation after HBeAg serological conversion , and no ALT abnormality, TBil abnormality and liver failure occurred.In non-standard withdraw group, only 17 cases without HBeAg serological conversion , 10 cases (58.8%) had positive HBV DNA conversion , 5 cases (29.4%) had ALT abnormalities, 2 cases (11.8%) had TBil abnormalities and liver failure did not occur.Conclusion CHB patients with medication of NAs should be discontinued according to the withdrawal criteria .and the course of medication, the immune index and the liver cirrhosis should be taken into account.