Clinical Outcomes of HBeAg-negative CHB Patients With Indeterminate Phase

Study Overview
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Brief Summary
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Chronic hepatitis B virus (HBV) infection remains a global public health burden around the world. Investigating the disease process of chronic hepatitis B (CHB) is essential to individual management in clinical practice. According to American Association for the Study of Liver Diseases (AASLD) 2018 Hepatitis B Guidance, CHB can be classified into four phases: immune-tolerant CHB, HBeAg-positive immune active CHB, inactive CHB and hepatitis B e antigen (HBeAg)-negative immune active CHB. Antiviral therapy is recommended in patients with HBeAg-positive or -negative immune active CHB patients to reduce the incidence of liver cirrhosis and hepatocellular carcinoma, while periodic monitoring is recommended for inactive carrier and immune-tolerant CHB patients. However, a substantial proportion of patients fall into an indeterminate phase whose serum HBV DNA and alanine aminotransferase levels do not fit well into these well-described phases. Most of CHB patients with indeterminate phase are HBeAg negative. However, the clinical outcomes of these patients remain unclear. Therefore, the purpose of this study is to investigate the clinical outcomes of HBeAg-negative chronic hepatitis B patients with indeterminate phase.

Official Title
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Clinical Outcomes of HBeAg-negative Chronic Hepatitis B Patients With Indeterminate Phase: a Multi-center, Prospective, Observational Cohort Study (PILOT)

Conditions
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Chronic Hepatitis b

Intervention / Treatment
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* Other: Observation
* Other: Antiviral treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hepatitis B surface antigen (HBsAg) positive over 6 months Age ≥18 years Treatment-naïve HBeAg negative, anti-HBe positive HBV DNA >2000 IU/mL Persistently normal alanine transaminase (ALT) Liver inflammation <G2 or A2 and liver fibrosis <S2 or F2 before enrollment, or liver stiffness >8 kilopascals (kPa) No family history of liver cirrhosis or hepatocellular carcinoma Exclusion Criteria: Coinfection with hepatitis A virus, hepatitis C virus, hepatitis D virus, hepatitis E virus or human immunodeficiency virus; Coexisting of hepatocellular carcinoma and other malignancy, or alpha-fetoprotein >upper limit of normal at enrollment; Presence of liver cirrhosis; Alcohol abuse within the last year (ethanol: male >40 g/d, female >20 g/d; or heavy drinking within 2 weeks before enrollment: ethanol >80 g/d), or history of drug abuse; Participating in other clinical trials in the last 3 months; Coexisting of autoimmune liver diseases; Pregnant or planned pregnancy in a short term or lactation patients; History of severe heart disease, mental disease; Uncontrolled diabetes, hypertension, thyroid dysfunction, retinopathy, autoimmune diseases; Neutrophil count <2×10^9/L and/or platelet count <100×10^9/L; History of organ transplantation or preparing for organ transplantation; Using immunosuppressive drugs; Undergone organ transplantation or preparing for organ transplantation; Receiving immunosuppressive agents; Patients thought by the investigators not suitable to participate in this study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Observation cohort<br> | Other: Observation<br>* Monitor every 6 months<br>|
| Treatment cohort<br> | Other: Antiviral treatment<br>* Receive first-line antiviral treatment, including entecavir, tenofovir disoproxil fumarate, tenofovir alafenamide, tenofovir amibufenamide or peginterferon<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of hepatocellular carcinoma at 240 weeks |  | 240 weeks | 
| The HBsAg clearance rate at 240 weeks |  | 240 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic hepatitis b, Indeterminate phase, hepatitis B surface antigen clearance, Hepatocellular carcinoma, Antiviral treatment