Challenging Conventional Wisdom: Early Treatment and Chronicity Outcomes in Acute Severe Hepatitis B

This study aimed to evaluate the clinical outcomes of patients diagnosed with acute severe hepatitis B (ASHB) who received early antiviral therapy compared to those who did not. Patients diagnosed with acute hepatitis B between February 2019 and February 2023 at our hospital were retrospectively analyzed for admission characteristics, antiviral treatments, and serum HBsAg and anti-HBs levels over 3-6-12 months. Acute severe hepatitis B was defined as serum total bilirubin > 5 mg or INR > 1.5. Of the 57 patients included, 26.3% (n=15) were female, and the median age was 40.2 (21-90) years. Within 48 hours of admission, 2 patients had concurrent diseases (3%) died. Two patients with concurrent HIV diagnosis were excluded. Treatment was initiated in 27 of 53 ASHB patients (entecavir/tenofovir: 24/3). One patient in the treatment group underwent liver transplantation due to fulminant hepatitis, and another patient died while on the waiting list. Long-term follow-up information for 3 patients in the untreated group was unavailable. The study continued with 25 treated and 23 untreated patients. No significant differences were observed in age, ALT levels, albumin, leukocyte, neutrophil, and platelet levels between the two groups (respectively; p = 0.57, p = 0.071, p = 0.187, p = 0.46, p = 0.94, p = 0.307). However, in the treated group, AST, total bilirubin, INR, and hospitalization duration were higher, and lymphopenia was more common. In the entire patient population, HBsAg seroclearance rates were 54% at 3 months (69% in treated vs. 34% in untreated; p = 0.127), 83.3% at 6 months (95% in treated vs. 74% in untreated; p = 0.218), and 100% at 12 months. Early antiviral therapy did not show an association with chronicity in ASHB patients. Conducting randomized controlled studies with a larger patient population is necessary to provide a definitive conclusion on initiating early antiviral therapy. However, such studies pose ethical challenges.