Top Journal Analysis | HBV RNA as an Effective Marker for Predicting Sustained Partial Cure

—— Introduction ——

Current treatments for chronic hepatitis B virus (HBV) infection have yet to achieve a complete cure. Therefore, identifying which patients undergoing long-term nucleos(t)ide analog (NA) therapy can safely discontinue medication and predicting their likelihood of achieving a sustained partial cure after cessation is of significant importance. This month, a study by the University of Southern California, published in The Journal of Infectious Diseases, explores the potential of the novel marker HBV RNA in assessing the likelihood of sustained partial cure in patients who discontinue therapy.

—— Methods ——

Current treatments for chronic hepatitis B virus (HBV) infection remain unable to achieve a cure. As a result, it is crucial to identify patients on long-term nucleos(t)ide analog (NA) therapy who can safely discontinue treatment and predict their likelihood of achieving a sustained partial cure after stopping. This month, a study from the University of Southern California, published in The Journal of Infectious Diseases, investigates the role of the novel marker HBV RNA in evaluating the potential for sustained partial cure in patients who discontinue therapy.

—— Results ——

Among the 93 participants who discontinued TDF treatment, 52 (55.9%) had HBV RNA levels below the detection limit at the end of therapy, while 41 (44.1%) were HBV RNA-positive. Of these 93 patients, 31 (33.3%) experienced acute ALT elevation (>5×ULN) after stopping treatment, including 27 HBV RNA-positive patients (65%, 27/41) and 4 patients with HBV RNA levels below the detection limit (7.6%, 4/52).

Further analysis revealed that 26 of the 93 patients (28.3%) achieved sustained partial cure, with 3 of them (11.5%) experiencing acute ALT elevation. The study demonstrated a strong correlation between HBV RNA levels, safe treatment discontinuation, and achieving sustained partial cure. Elevated HBV RNA levels were associated with reduced likelihood of safe treatment discontinuation and achieving sustained partial cure (Figure 1).

At the end of treatment, HBV RNA levels below the detection limit and qHBsAg < 100 IU/mL were identified as the best predictors for achieving sustained partial cure (AUROC 0.84 and 0.93, respectively). If HBV RNA was positive at the end of treatment, the likelihood of achieving sustained partial cure was only 3%. In contrast, if HBV RNA was below the detection limit and qHBsAg < 100 IU/mL, the likelihood increased significantly to 73% (Figure 2).

Figure 2

HBV RNA is a useful biomarker for predicting the likelihood of achieving sustained partial cure and safely discontinuing NA therapy.