Spontaneous
Undetectable Hepatitis B Virus DNA Is Uncommon, especially without
HBeAg Clearance
 |
 |
 |
 |
 |
 |
 |
| SUMMARY:
Clearance of hepatitis B virus (HBV) DNA from the
blood seldom occurs without treatment even after a
decade, researchers reported at the 45th Annual Meeting
of the European Association for the Study of the Liver
(EASL 2010) last month
in Vienna. Among people who experience hepatitis B
"e" antigen (HBeAg) clearance, however,
the likelihood of also achieving undetectable viral
load was higher, approaching 50% at 10 years. |
|
 |
 |
 |
 |
 |
 |
 |
By
Liz Highleyman
C-J.
Chen from National Taiwan University and colleagues assessed
the likelihood and factors associated with spontaneous clearance
of HBV viral load in a sub-study of the large REVEAL-HBV trial,
which looked at long-term outcomes including liver cancer among
people with chronic hepatitis B.
The sub-study included 1289 participants with high HBV DNA levels
(> 10,000 copies/mL) but no evidence of cirrhosis
at study entry.
Results
 |
199
participants (15.4%) achieved undetectable HBV DNA (<
100 copies/mL) during follow-up. |
|
HBV
DNA became undetectable after an average of 7.8 years, for
a clearance rate of 19.7 per 100,000 person-years. |
|
Overall,
the cumulative likelihood of achieving undetectable HBV
DNA was 5.2% at 5 years and 14.5% at 10 years. |
|
Looking
only at participants who experienced HBeAg clearance, however,
cumulative HBV DNA clearance rates were higher, 11.5% at
5 years and 45.5% at 10 years. |
|
In
a multivariate analysis, having a baseline viral load of
100,000-999,999 copies/mL (versus > 1 million
copies/mL) and abdominal obesity were associated with greater
likelihood of spontaneous HBV DNA clearance. |
|
In
contrast, elevated alanine aminotransferase (ALT) -- both
15-44 U/L and > 45 U/L versus < 15 U/L -- was
associated with lower likelihood of achieving undetectable
HBV DNA. |
|
Most
participants (89%) who were initially HBeAg seropositive
had already cleared HBeAg by the time they achieved undetectable
HBV DNA. |
|
Conversely,
a majority of participants had viral load > 10,000
copies/mL at the time of HBeAg clearance. |
"Spontaneous
seroclearance of HBV DNA was a rare event, even after HBeAg
seroclearance," the investigators concluded. "Lower
baseline viral load and central obesity [were] associated with
higher possibility of decreasing HBV DNA to undetectable level,
whereas higher serum ALT level during follow-up associated with
a lower possibility of HBV DNA decline."
Genomics Research Center, Academia Sinica, National Taiwan
University, Taipei, Taiwan ROC; Research and Development, Bristol-Myers
Squibb Company, Willingford, CT.
5/14/10
Reference
C-J Chen, H-I Yang, C-L Jen, and others. Incidence and determinants
of spontaneous decline of HBV DNA to undetectable level in patients
with high viral load. 45th Annual Meeting of the European Association
for the Study of the Liver (EASL 2010). Vienna, Austria. April
14-18, 2010. (Abstract).
