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When to Stop Antiviral Therapy in HBeAg-Negative Patients with Chronic Hepatitis B?

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Abstract

Purpose of Review

The strategy of finite nucleos(t)ide analogue (Nuc) therapy in HBeAg-negative patients has been increasingly accepted globally, and when to stop therapy has become an important issue. This review aimed to address this issue.

Recent Findings

The incidence of off-therapy relapse is lower with lower end-of-therapy (EOT) HBsAg level. Pretherapy HBV DNA < 20,000 IU/mL, on-treatment HBV DNA undetectable by week 12, treatment duration > 3 years, on-treatment HBsAg decline > 1 log10 IU/mL, and EOT HBsAg < 100 IU/mL are also factors for increasing off-therapy HBsAg loss. Off-therapy hepatitis flare may occasionally deteriorate to hepatic decompensation, which can be prevented/rescued by timely retreatment whereas “no-retreatment” is an important factor for HBsAg loss.

Summary

All patients meeting recommended stopping criteria are eligible for Nuc withdrawal. The favorable factors for low relapse rate and high HBsAg loss rate can be used to encourage patients to stop Nuc therapy and adhere to off-Nuc monitoring plan.

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Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

AASLD:

American Association for the Study of Liver Diseases

aHR:

Adjusted hazard ratio

ALT:

Alanine aminotransferase

APASL:

Asian-Pacific Association for the Study of the Liver

cccDNA:

Covalently closed circular DNA

CHB:

Chronic hepatitis B

CR:

Clinical relapse

EASL:

European Association for the Study of the Liver

EOT:

End of therapy

ETV:

Entecavir

HBeAg:

Hepatitis B e antigen

HBsAg:

Hepatitis B surface antigen

HBV:

Hepatitis B virus

HBV-LC:

HBV-related cirrhosis

HCC:

Hepatocellular carcinoma

IC:

Inactive carrier

iDNA:

Integrated HBV DNA

Nuc:

Nucleos(t)ide analogue

qHBsAg:

Quantitative HBsAg

SR:

Sustained response

TAF:

Tenofovir alafenamide

TDF:

Tenofovir disoproxil fumarate

ULN:

Upper limit of normal

VR:

Virologic relapse

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Acknowledgements

The author thanks Ms. Su-Chiung Chu for her secretary assistance and preparation of the manuscript.

Funding

YFL has been supported by grants from Chang Gung Medical Research Fund (CMRPG1K0101-3, CMRPG1K0111-3, CMRPG1N0111) and the Prosperous Foundation, Taipei, Taiwan.

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Authors and Affiliations

  1. Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199, Tung Hwa North Road, Taipei, 105, Taiwan

    Yun-Fan Liaw

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Yun-Fan Liaw wrote the whole manuscript text.

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Correspondence to Yun-Fan Liaw.

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Liaw, YF. When to Stop Antiviral Therapy in HBeAg-Negative Patients with Chronic Hepatitis B?. Curr Hepatology Rep 23, 221–226 (2024). https://doi.org/10.1007/s11901-024-00663-6

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