Influence of HBeAg seroconversion on virological relapse in chronic hepatitis B patients on withdrawal of nucleos(t)ide analogues therapy

Objective To explore the influence of HBeAg seroconversion on virological relapse in HBeAg-positive chronic hepatitis B patients who stopped nucleos(t)ide analogues therapy.Methods We retrospectively studied 60 HBeAg-positive chronic hepatitis B(CHB) patients who had stopped nucleos(t)ide analogues therapy.The total duration of treatment was ≥ 12 months.ALT,HBV DNA and HBV serological markers were measured respectively at baseline,every month before HBV DNA1.0×103copies/ml,and every 3 month after HBV DNA1.0×103copies/ml.After the drug withdrawal,we continued to follow up for at least 6 months,to observe whether or not there were relapse.HBeAg loss/seroconversion occurred at the end of the therapy were analyzed for relapse.For those patients who had HBeAg seroconversion,relapse rates in 3 groups according to duration of additional treatment(≤ 12 months,12-24 months, 24 months) were compared.Results Of 60 patients,60%(36cases) relapsed within 6 months.8 cases were without HBeAg loss(A),100% relapsed within 4 months after drug withdrawal;6 cases occurred HBeAg loss but without HBeAb(B),83.3%(5 cases) relapsed within 6 months;46 cases occurred HBeAg seroconversion(C),50%(23 cases) relapsed within 6 months,χ2=11.585,P=0.003.There was statistical significance between A group and C group,χ2=6.84,P=0.015;But there was no statistical significance between B group and A group,χ2=1.333,P=0.248,and between B group and C group,χ2=2.327,P=0.199;For 46 patients who occurred HBeAg seroconversion,patients were assigned to the 3 groups(A,B,C) ≤ 12 months(11cases),12-24 months(23cases), 24 months(12cases) respectively.The relapse rates of group A,B,and C at 6 months were 100%(11cases),47.8%(11cases),8.3%(1case)respectively,χ2=19.377,P=0.000.There was statistical significance between A group and B group,χ2=8.609,P=0.003;between A group and C group,χ2=19.326,P=0.000;between B group and C group,χ2=5.303,P=0.027.Conclusion HBeAg seroconversion can be seen as a basic end point in the treatment of chronic hepatitis B.when duration of additional treatment after HBeAg seroconversion are ≤ 12 months,relapse rate after drug withdrawal is still high.If the duration of additional treatment after HBeAg seroconversion are 24 months,it is expected to gain sustained virological response,but all patients should be closely followed up within 6 months after the drug withdrawal.