Author information

• ¹Baylor Scott and White Medical Center, Dallas, Texas, USA.
• ²Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
• ³Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
• ⁴Liver Diseases Branch, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
• ⁵Gastrointestinal and Liver Diseases Division, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
• ⁶Departments of Epidemiology and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
• ⁷Toronto Centre for Liver Diseases, University Health Network, Toronto, Ontario, Canada.

Abstract

Introduction: We aimed to determine whether the intensity of alanine aminotransferase (ALT) flares during antiviral therapy is associated with the level of hepatitis B surface antigen (HBsAg) decline.

Methods: Quantitative HBsAg was determined during tenofovir monotherapy or tenofovir plus peginterferon alfa-2a in 201 participants with hepatitis B e antigen-positive or -negative chronic hepatitis B. A multivariable analysis identified factors associated with a shorter time to reduction in HBsAg.

Results: Fifty flares occurred during treatment of which 74% were moderate (ALT >5-10 × upper limit of normal) or severe (ALT >10 × upper limit of normal). These flares were associated with greater HBsAg decline compared with no flares. Significantly faster times to HBsAg decline >1 log 10 IU ( P = 0.04) and to HBsAg level <100 IU/mL ( P = 0.01) were observed with severe flares.

Discussions: Flare severity is a potentially important factor associated with shorter time to HBsAg reduction. These findings can be useful when evaluating HBsAg response to evolving hepatitis B virus therapies.