Relapse of hepatitis B e antigen-positive patients after standardized interferon α regimen: A five-year follow-up study

Objective To estimate relapse of hepatitis B in HBeAg-positive chronic hepatitis B patients who accept standardized interferon-alpha α (IFN-α) regimen during 5-year follow-up observation and evaluate the factors influencing relapse of hepatitis B. Methods We retrospectively analyzed 169 initial responders to standardized IFN-α therapy during 5-year follow-up. The clinical data and laboratory data, treatment regimen and relapse of the illness were recorded. The Kaplan-Meier method was used to calculate cumulative relapse rate; The χ² test, student's t test and Cox proportional hazards regression model were used to analyze the correlation between the potential risk factors and relapse. Results The cumulative relapse rates at 1, 2, 3, 4, and 5 year posttreatment were 21.9%, 28.4%, 32.0%, 33.1% and 34.3% respectively; Relapse was related to age, serum hepatitis B virus deoxyribonucleic acid (HBV DNA) and hepatitis B surface antigen (HBsAg) levels, decline in serum HBsAg levels at the end of treatment, HBV genotype and duration of IFN-α therapy by univariate analysis; According to Cox regression, duration of IFN-α therapy and serum HBsAg levels at the end of treatment were two main indicators for relapse of hepatitis B; The relative risk (RR) were 0.640 (95% CI:0.413-0.991) and 1.789 (95% CI:1.218-2.629) respectively. The positive predictive value (PPV) and negative predictive value (NPV) of serum HBsAg being 2 lg IU/ml or greater at end of treatment was 49.5% and 90.6% for prediction of relapse. Conclusions Shorter duration of IFN-α therapy and higher serum HBsAg levels at the end of treatment are risk factors for relapse of hepatitis B, prolongation of IFN-α therapy might reduce risk of relapse, and serum HBsAg quantification may be useful in determining course of individualized IFN-α treatment.