LAUSR

We have read with great interest the article published by Koh et al., which discussed clinical risk factors associated with change in management in chronic hepatitis B patients. The authors reported that treatment change was needed in 24.3% of the patients and change was unpredictable in four patients. In one patient, the cause of treatment change could not be defined. Use of interpreter, known liver cirrhosis and immunosuppressive treatment were found to be related with treatment change in patients with chronic hepatitis B infection. Interferon (IFN) and nucleos(t)ide analogues (NA) are the hallmark treatment options in patients with chronic hepatitis B infection. There are several hepatitis B virus (HBV) genotypes and some of the HBV genotypes are related with prognosis and loss of HBeAg and HBsAg. Genotype A is associated with the loss of HBeAg with IFN or NA therapy in HBeAg positive patients. However, genotype A is not related with HBsAg loss in patients with chronic hepatitis B infection. Therefore, HBV genotype may play a role in treatment failure and change in management. Tenofovir disoproxil fumarat (TDF) is used in treatment of human immodeficiency virus (HIV) and HBV infections. TDF is related with Fanconi syndrome and decline in glomerular filtration rate. Despite the incidence rate of Fanconi syndrome being low, it may cause change in management. To conclude, we think that although it is difficult to detect due to the retrospective nature of the study, it could be improved if HBV genotype and occurrence of Fanconi syndrome were also assessed as being possible candidates for cause of management change in patients with HBV infection.