Serum hepatitis B virus RNA as a predictive biomarker for HBeAg seroconversion during entecavir and tenofovir disoproxil fumarate therapy in chronic hepatitis B patients.

BACKGROUND AND AIM: chronic hepatitis B (CHB) affects millions globally and is a leading cause of liver cirrhosis and hepatocellular carcinoma. Nucleos(t)ide analogues (NAs) such as entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are effective in suppressing hepatitis B virus (HBV) replication. However, functional cure, defined by hepatitis B surface antigen (HBsAg) clearance, remains challenging. Reliable biomarkers are needed to predict treatment outcomes.

METHODS

this study retrospectively analyzed 293 hepatitis B e antigen (HBeAg) positive CHB patients undergoing TDF or ETV treatment. Serum HBsAg, HBeAg, HBV DNA, and HBV RNA levels were measured at baseline and every six months during 24 months. Kaplan-Meier and Cox regression analyses were performed to evaluate the relationship between HBV RNA levels and HBeAg seroconversion.

RESULTS

HBeAg seroconversion occurred in 129 patients, with a median time of 14 months. Lower baseline and six-month HBV RNA levels were associated with higher seroconversion rates. Multivariate analysis confirmed HBV RNA as an independent predictor of seroconversion. Receiver operating characteristic (ROC) analysis showed that HBV RNA levels outperformed other markers to predicting outcome, with the combined use of baseline and six-month levels achieving the highest predictive accuracy.

CONCLUSION

HBV RNA is a promising biomarker to predict HBeAg seroconversion during NAs therapy. Its use could enhance personalized treatment strategies for CHB patients.