Wu Jia-Feng, Tai Chi-San, Chang Kai-Chi, Chen Yuh-Jue, Hsu Chien-Ting, Chen Huey-Ling, Ni Yen-Hsuan, Chang Mei-Hwei
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Clin Gastroenterol Hepatol. 2025 Mar;23(4):583-590.e3. doi: 10.1016/j.cgh.2024.07.036. Epub 2024 Aug 28.
BACKGROUND & AIMS: A functional cure is an essential endpoint in the management of patients with chronic hepatitis B virus (HBV) infection. We evaluated the cumulative probability and predictors of functional cure in patients with chronic HBV infection after hepatitis B e antigen (HBeAg) seroconversion.
We retrospectively analyzed 413 (249 males and 164 females) initially HBeAg-positive chronic HBV-infected patients who were followed up for a mean of 26.36 ± 0.53 years. All underwent HBeAg seroconversion during follow-up. A functional cure was defined as durable HBsAg and HBV DNA loss without antiviral treatment for more than 24 weeks.
After 10,888 person-years of follow-up, the cumulative probability of functional cure was 14.53% (n = 60). There were 24 (40%) subjects with functional cure after antiviral therapy. The annual functional cure rate was 0.55% per person-year, and increased to 0.96% per person-year after HBeAg seroconversion. In subjects with functional cure, the HBsAg and HBV DNA titers after HBeAg seroconversion were positively correlated with the time to functional cure (P < .001 and < .001, respectively). Multivariate Cox proportional hazards analysis of the cohort revealed that HBeAg seroconversion at <18 years of age, high-genetic-barrier nucleos(t)ide analogue(s) therapy before HBeAg seroconversion, and a serum HBsAg titer <1000 IU/mL at 18 months after HBeAg seroconversion were significant predictors of functional cure (P < .001, .001, and .001, respectively).
In a cohort of chronic HBV-infected patients with long-term follow-up, HBeAg seroconversion in childhood, high-genetic-barrier nucleos(t)ide analogue(s) therapy, and low HBsAg titers after HBeAg seroconversion were significant predictors of functional cure.
功能性治愈是慢性乙型肝炎病毒（HBV）感染患者管理中的一个重要终点。我们评估了乙型肝炎e抗原（HBeAg）血清学转换后慢性HBV感染患者功能性治愈的累积概率及预测因素。
我们回顾性分析了413例（249例男性和164例女性）最初HBeAg阳性的慢性HBV感染患者，他们的平均随访时间为26.36±0.53年。所有患者在随访期间均发生了HBeAg血清学转换。功能性治愈定义为在未进行抗病毒治疗的情况下，HBsAg和HBV DNA持续丢失超过24周。
经过10888人年的随访，功能性治愈的累积概率为14.53%（n = 60）。抗病毒治疗后有24例（40%）患者实现了功能性治愈。每年的功能性治愈率为每人年0.55%，HBeAg血清学转换后升至每人年0.96%。在实现功能性治愈的患者中，HBeAg血清学转换后的HBsAg和HBV DNA滴度与功能性治愈时间呈正相关（P分别<0.001和<0.001）。对该队列进行多变量Cox比例风险分析显示，18岁之前发生HBeAg血清学转换、HBeAg血清学转换前使用高基因屏障核苷（酸）类似物治疗以及HBeAg血清学转换后18个月时血清HBsAg滴度<1000 IU/mL是功能性治愈的显著预测因素（P分别<0.001、0.001和0.001）。
在一组长期随访的慢性HBV感染患者中，儿童期HBeAg血清学转换、高基因屏障核苷（酸）类似物治疗以及HBeAg血清学转换后低HBsAg滴度是功能性治愈的显著预测因素。
