Introduction Tenofovir and Entecavir are direct acting antivirals used in the treatment of chronic hep B infection. We describe our hospital experience of the effectiveness of these antiviral drugs in terms of HbeAg seroconversion, development of drug resistence and incidence of hepatocellular carcinoma during treatment.
Methods All patients treated with Tenofovir or Entecavir between 2010 and 2013 at Guy’s and St Thomas hospital trust were identified from hospital pharmacy database. Baseline HBV DNA levels, ALT and albumin levels were recorded on three monthly intervals for upto 48 months.
Results A total of 132 patients were identified. 84 patients were on Tenofovir (17 pregnant women). Among them, 38% (n = 32) were HbeAg positive, and 26% (n = 22) were cirrhotic. The remaining 48 patients were on Entecavir. Of these, 27% (n = 13) were HbeAg positive and 31% (n = 15) were cirrhotic when treatment was started. The mean baseline HBV DNA levels for HbeAg positive patients were 7.0 log 10 IU (P = 0.0170) and 5.4 log 10 IU (P = 0.0153) for Tenofovir and Entecavir respectively. The mean baseline HBV DNA levels in cirrhotic patients were 4.6 log 10 IU and 4.7 log 10 IU for Tenefovir and Entecavir patients respectively.
Sub group analysis showed that HbeAg negative patients achieved early undetectable viral loads (mean 2.1 months on tenefovir, mean 2.8 months on entecavir). HbeAg positive patients achived undetectable viral loads relatively later (mean 11 months on Tenefovir,mean 9 months on Entecavir).
HbeAg seroconversion was achieved in 19% (n = 6) of patients on Tenofovir and 15% (n = 2) of patients on Entecavir. Treatment with both antivirals was associated with improvement in synthetic function in cirrhotic patients. Drug resistance occurred in one patient on Entecavir and none of the patients on Tenefovir. Four patients (2 patients on Tenofovir and 2 on Entecavir) developed hepatocellular carcinoma during treatment, all of whom were cirrhotic prior to treatment.
Among the 17 pregnant patients treated with Tenofovir, 10 patients were HbeAg positive. The mean pre-treatment baseline HBV DNA levels were 6.8 log 10 IU. HbeAg seroconversion was noted in 2 patients.
Conclusion Treatment of chronic hepatitis B infection with both Tenofovir and Entecavir were well tolerated. Undetectable viral loads were achieved in both groups within 12 months of starting treatment. HbeAg seroconversion was noted in 19% (n = 6) patients treated with Tenofovir and 15% (n = 2) patients treated with Entecavir. Overall there was no significant difference in the mean time to undetectable viral loads in patients treated with Tenofovir (7.5 months) and Entecavir (6.1 months).
Reference Marecellin P, Heathcote EJ, Buti M, et al. NICE-Entecavir for the treatment of chronic hepatitis B.
Disclosure of Interest None Declared.