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

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Abstract

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 × the upper limit of normal, HBV DNA levels <9 log10 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.

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Acknowledgments

The authors wish to thank Kathleen Covino, Ph.D., for her editorial support in the development of this manuscript. The authors acknowledge Novartis Pharma AG for their financial support of the meeting.

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Authors and Affiliations

  1. Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 199 Tung Hwa North Road, Taipei, 105, Taiwan

    Yun-Fan Liaw

  2. Clinical Trial Center, LKS Faculty of Medicine, The University of Hong Kong, Humanity and Health GI and Liver Clinic, Unit 1309, No. 9 Queen’s Road Central, Hong Kong, SAR, China

    George K. K. Lau

  3. Hepatitis Research Center National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 10016, Taiwan

    Jia-Horng Kao

  4. New Zealand Liver Transplant Unit, Auckland City Hospital, Private Bag 92024, Auckland, 00142, New Zealand

    Edward Gane

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Correspondence to Yun-Fan Liaw.

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Liaw, YF., Lau, G.K.K., Kao, JH. et al. Hepatitis B e Antigen Seroconversion: A Critical Event in Chronic Hepatitis B Virus Infection. Dig Dis Sci 55, 2727–2734 (2010). https://doi.org/10.1007/s10620-010-1179-4

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