The impact of early hepatitis B virus viral suppression on treatment response in entecavir-treated hepatitis B e antigen-positive chronic hepatitis B

To investigate the impact of early HBV DNA suppression after receiving entecavir (ETV) on treatment response in hepatitis B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients. A total of 140 baseline HBV DNA-matched HBeAg-positive patients receiving ETV were enrolled. Of those 70 patients achieved early virological response at week 24 (VR24 group) and the remaining 70 patients failed to achieve VR24 (non-VR24 group). Factors of serological and virological outcomes were analyzed. Patients with pretherapy alanine aminotransferase (ALT) levels over five times upper limit of normal had a higher HBeAg seroclearance rate (P = .038). The VR24 group had the higher ratio of HBeAg seroclearance and maintained viral suppression within 96 and 144 weeks, respectively (53% and 75%, respectively). The cumulative rates of virological breakthrough (VBT) in the VR24 group and non-VR24 group were 0% and 5.71%, 3.2% and 11.83%, 3.2% and 17.24%, 3.2% and 17.24%, and 3.2% and 21.84% from week 48 to 240, every 48 weeks, respectively (P = .006). In the multivariate analysis, undetectable HBV DNA and age at week 24 were associated with VBT (P = .02 and .006, respectively). Pretherapy ALT levels predicted a higher probability of HBeAg seroclearance. VR24 could be associated with HBeAg seroclearance and maintained viral suppression during therapy. Detectable HBV DNA at week 24 and older age could be predictive factors with an occurrence of VBT in HBeAg-positive CHB patients treated with ETV.