Role of hepatitis B surface antigen in hepatitis B virus relapse after entecavir or tenofovir prophylaxis in patients undergoing cancer chemotherapy

摘要

Abstract Background and Aim This study investigated whether hepatitis B surface antigen (HBsAg) could predict hepatitis B virus (HBV) relapse after cessation of entecavir or tenofovir disoproxil fumarate (TDF) prophylaxis for chronic hepatitis B cancer patients who are undergoing chemotherapy. Methods The study enrolled 122 hepatitis B e‐antigen‐negative cancer patients who underwent chemotherapy with entecavir or TDF for antiviral prophylaxis and posttreatment follow‐up for at least 6?months. Results Of the 122 patients, 52 and 18 experienced virological and clinical relapse, which had 3‐year cumulative incidences of 46.6% and 18.6%, respectively. Multivariate analysis showed that end‐of‐treatment HBsAg levels and baseline HBV‐DNA?≥?2000?IU/mL were independent predictors of virological relapse. The best HBsAg cutoff value was 500?IU/mL. An end‐of‐treatment HBsAg of 500?IU/mL was useful for predicting virological relapse in patients with baseline HBV‐DNA??2000?IU/mL (3‐year rate: 21.3% vs 46.4%, P ?=?0.038, in patients with HBsAg ?500 and ≥?500?IU/mL, respectively), but not in patients with baseline HBV‐DNA?≥?2000?IU/mL. Of the 52 patients who experienced virological relapse, 13 experienced transient virological relapse. Patients with baseline HBV‐DNA level??2000?IU/mL experienced a higher rate of transient virological relapse (42.1% vs 15.2%, P ?=?0.031). Three patients experienced hepatic decompensation upon alanine aminotransferase flares, and no patient died after timely retreatment. Ten patients experienced posttreatment HBsAg loss, and the 3‐year HBsAg loss rate was 30.7% in patients with end‐of‐treatment HBsAg??100?IU/mL. Conclusions The baseline HBV‐DNA and end‐of‐treatment HBsAg levels could predict virological relapse after withdrawal of entecavir and TDF prophylaxis for chemotherapy.