Association of ALT Flares to Hepatitis B Surface Decline During Tenofovir Alone or with Pegylated Interferon Alfa.

INTRODUCTION We aimed to determine if the intensity of ALT flares during antiviral therapy is associated with the level of hepatitis B surface antigen (HBsAg) decline. METHODS Quantitative HBsAg was determined during tenofovir monotherapy or tenofovir plus peginterferon alfa-2a in 201 participants with HBeAg-positive or negative CHB. A multivariable analysis identified factors associated with a shorter time to reduction in HBsAg. RESULTS Fifty flares occurred during treatment of which 74% were moderate (ALT > 5-10 x ULN) or severe (ALT > 10 x ULN). These flares were associated with greater HBsAg decline compared to no flares. Significantly faster times to HBsAg decline >1 log10 IU (p=0.04) and to HBsAg level <100 IU/mL (p=0.01) were observed with severe flares. DISCUSSIONS Flare severity is a potentially important factor associated with shorter time to HBsAg reduction. These findings can be useful when evaluating HBsAg response to evolving HBV therapies.

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