Kinetics of quantitative HBsAg during antiviral therapy of chronic hepatitis B.

Gaurav, Chawla (2013) Kinetics of quantitative HBsAg during antiviral therapy of chronic hepatitis B. Masters thesis, Christian Medical College, Vellore.

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Abstract

Chronic HBV infection is prevalent in Indian population with prevalence rate of 2-4% . It is wellknown to cause chronic hepatitis , chronic liver disease and hepatocellular carcinoma (HCC). It is the most common cause of liver cirrhosis and hepatocellular carcinoma in most parts of Asia. It is a global health issue resulting in significant annual mortality world wide . Studies from India have shown predominance of Genotype D and A. Patients with high viral counts and persistent inflammation ( elevated liver enzymes or histopathologically) have more incidence of disease progression and related complication . Both e antigen and surface antigen reproduced by Hepatitis B virus. These markers are useful in diagnosis and management of patients with hepatitis B. HBeAg seroconversion is important in natural history of CHB patients as it indicates decline in viral replication and subsequent remission of liver disease. 20 - 30 % seroconverted patients may have reactivation of hepatitis B virus which may progress to E antigen negative chronichepatitis . Such patients are still prone for development of chronic liver disease and HCC. There are 4 phases in the natural history of chronic HBV infection : immune tolerant (IT) , immune clearance (IC) , lowreplicative (LR) and E antigen negative hepatitis (ENH) . These phases are defined by specific virological, biochemical and serological characteristics including liver enzymes , DNA loads , e Antigen status . These phases are not necessarily sequential and do not occurs in all individuals. Antiviral therapy including nucleos(t)ide inhibitors or interfern therapy can lead to biochemical and virological remission. Recent evidence suggests that response to anti viral therapy is extrapolated in to reduced incidence of chronic liver disease and hepato cellular carcinoma. Interferon therapy is effective only in 30-40 % of patients and its use is limited by side effects and high costs. AIMS : Primary Objective : To study the pattern of decline in Hepatitis B surface antigen levels (qHBsAg) on anti-viral therapy (both nucleos(t)ide and interferon therapy) and its correlation with decline in HBV DNA levels. Secondary Object ives: 1 . Study the predictors of virological response . 2 . Study the correlation o f qHBsAg decline with e antigen status , ALT. CONCLUSIONS : Absence of any reduction in qHBsAg levels was associated with absence of response to IFN. There was no significant reduction in qHBsAg levels after 18 months of NA therapy despite significant reduction in DNA levels. Baseline HBV DNA level and not qHBsAg level was the only predictor of complete virological response. No meaningful correlation was noted between qHBsAg and HBV DNA levels with either ETV or with TDF therapy. There was no correlation noted between ALT level and qHBsAg level during antiviral therapy. The trend of qHBsAg levels needs to be monitored long term along with DNA levels while on NA therapy so that eventual sustained viral response after NA cessation can be predicted.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Kinetics ; quantitative HBsAg ; antiviral therapy ; chronic hepatitis B.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 06:07
Last Modified: 14 Jul 2017 06:07
URI: http://repository-tnmgrmu.ac.in/id/eprint/1638

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