Aliment Pharmacol Ther 2010; 32: 97–104
Summary
Background Some patients continue to have detectable HBV‐DNA levels with liver disease progression after hepatitis B e antigen (HBeAg) loss. It is important to identify these patients, candidates for long‐term treatment.
Aims To evaluate hepatitis B virus (HBV) genotype and the main mutations in the basic core promoter (BCP, A1762T/G1764A) and precore (G1896A) sequences as markers of persistent HBV‐DNA after HBeAg loss.
Methods We analysed 60 serum samples from 20 Caucasian, HBeAg‐positive, chronic hepatitis B patients, who lost HBeAg and were followed‐up longitudinally. HBV genotype and precore and BCP mutations were determined before, at the time of, and after HBeAg loss.
Results After HBeAg loss, eight (40%) patients continued to have undetectable HBV‐DNA and 12 (60%) had persistent HBV‐DNA (median level 4.7 log10 copies/mL). The presence of BCP mutations prior to therapy was the only variable associated with persistently detectable viraemia (P = 0.017). Four patients with genotype A and no mutations in the BCP region experienced hepatitis B surface antigen (HBsAg) loss after a mean period of 35 months from baseline.
Conclusions Main BCP mutations in HBeAg‐positive patients are useful markers to identify patients who will not have sustained virological suppression after HBeAg loss and therapy discontinuation and could benefit from long‐term treatment.