seroclearance ofhbsag in chronic hepatitis...
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SEROCLEARANCE OF HBSAG IN CHRONIC HEPATITIS B VIRUS
PATIENTS ON LAMIVUDINE, TENOFOVIR OR ENTECAVIR THERAPY:
A 10 YEARS EXPERIENCE.
Felipe Pereira de Souza, Mariana Akemi Nabeshima, Luís Cláudio Alfaia Mendes, Denise Cerqueira Paranaguá-
Vezozzo, Rodrigo Martins Abreu, Flair José Carrilho, Suzane Kioko Ono
Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology
University of São Paulo School of Medicine, São Paulo, Brazil;
HEP DART 2017ABSTRACT NUMBER: 13
December 6th 2017
BACKGROUND
In Brazil, HBV antivirals are given by government (SUS – Unique/Universal
Health System). Universal access to every citizen who needs treatment
HBsAg loss, with or without anti-HBs seroconversion, is an optimal endpoint,
as it indicates profound suppression of HBV replication and viral protein
expression
Long term HBsAg seroclearence frequency with nucleos(t)ide analogs (NUC)
treatment is still not well established in Brazil
Ministerio da Saude – PCDT HBV 2017AASLD, EASL, APASL HBV Guidelines 2017
AIMS
□ This study aimed to investigate the efficacy on HBsAg clearance of
Lamivudine, Entecavir and Tenofovir in a cohort of chronic hepatitis B
patients.
CASUISTIC AND METHODS
□ Retrospective descriptive study;
□ 156 new patients treated with Lamivudine (150mg/day), Entecavir(0.5 mg/day), Tenofovir (300 mg/day) or combinations;
□ Patients followed up in the A2MG404 ambulatory (Hospital dasClínicas, São Paulo, Brazil) between January 1st 2005 and December31th 2015.
CASUISTIC AND METHODS
□ Demographic, epidemiological and clinical data were obtained frominstitutional electronic medical records (SIGH-PRODESP, HCMED andProntMed);
□ Data collection and management – REDCap (V6.16.4);
□ Statistical analysis – R software (V3.3.0).
□ Patients selection algorithm andeligibility criteria:
STUDY POPULATION (N=156)
LAMIVUDINE 150 mg(n=30)
TENOFOVIR 300 mg(n= 47)
ENTECAVIR 0.5 mg (n= 29)
COMBINED THERAPY
(n= 50)LAM +TDF (n= 35)LAM + ADF (n= 5)ENT + TDF (n=8)ENT + ADF (n=2)
□ Sub-groups division:
RESULTS
‘
Baseline characteristics of patients
‘
‘
RESULTS
Baseline characteristics of patients
‘
Prevalence of HCV and HIV infections in patients infected with HBV
HBV+HCV HBV+HIV HBV+HCV+HIV
5(3.20%)
3(1.92%)
1(0.64%)
‘
Patient’s country of birth
‘Brazil China Poland Cameroon Not declared
151(96.79%)
2(1.28%)
1(0.64%)
1(0.64%)
1(0.64%)
Population schooling level
Primary educationcompleted
Incompleteprimary education
High schoolcompleted
Undergraduatecompleted
Incomplete highschool
Illiterate Incompleteundergraduate
Not declared
54(34.61%)
33(21.15%) 31
(19.87%)
13(8.33%)
8(5.13%) 5
(3.20%)5
(3.20%)
7(4.49%)
‘
HBsAg and HBeAg loss rates according to treatment
‘
‘
Therapeutic scheme: Lamivudine + Tenofovir
LAM or LAM combo 7/70 (10%) HBsAg loss (n.s.)
LAM resistance 40/70 (57%)
Comparison between the final parameters of patients with HBV treated with Lamivudine, Tenofovir or Entecavir
‘
‘
lossloss
lossloss
LAM or LAM combo 7/70 (10%) HBsAg loss (n.s.)
Treatment SEX AGE AgHBe Cirrhosis ANTIHBS
LAM FEMALE 73 NEG Yes NR < 2 IU/ML
LAM MALE 55 POS No NR < 2 IU/ML
LAM MALE 59 NEG Yes R 28.81 IU/ML
LAM MALE 50 NEG Yes R 706 IU/ML
LAM MALE 70 NEG Yes R 469.6 IU/ML
LAM +TDF FEMALE 66 POS No R >1000 IU/ML
LAM +TDF MALE 50 POS Yes R 41.13 IU/ML
TDF FEMALE 59 POS No NR < 2 IU/ML
TDF MALE 62 POS Yes NR < 2 IU/ML
HBsAg seroconversion
CONCLUSIONS
□ Long term viral suppression with nucleoside analogues leads to HBsAg loss
and cure may be well within reach with oral antivirals.
□ When resistance to lamivudine is not present HBsAg loss is possible
□ It is of note that the dose of lamivudine (150 mg) used in this study is higher
than the dose used outside Brazil.
Time to hit HIV (HBV) early and hard
David Ho, NEJM 1995
Thank you!
Felipe Pereira de Souza Luiz Cláudio A Mendes Rodrigo Martins Abreu Julia PiresNAYARA LOPES LUCENA Daniel Nakagawa Vera Kim Ramon Bispo
Cassiana Alves Mariana Nabeshima Denise RodriguesVictor Van Vaisberg
Residents Gastroenterologia Clínica Maria Cleusa Martins GoesResidents Assistência Farmacêutica Denise Paranagua-Vezozzo
Flair José Carrilho