Hepatitis B virus (HBV) infection is not yet completely eradicated. Potent and safe long-term treatment with nucleoside (acid) analogs (NUC) can significantly inhibit viral replication, reduce liver cirrhosis and related complications and the incidence of hepatocellular carcinoma (HCC). However, NUC cannot completely clear the covalently closed circular DNA (cccDNA) in HBV replication template liver cells, and it is difficult to obtain HBsAg clearance, and the annual negative rate of HBsAg is only 0.15%-0.33%.
Arbitrary discontinuation of NUC can lead to virological relapse and elevated transaminases, which in turn increase the risk of hepatic decompensation, fibrosis progression, HCC or liver disease-related death Risk occurs.
For HBeAg-positive CHB patients without cirrhosis, the three major guidelines of my country and the Asian, European and American Society of Liver Diseases are all recommended.When HBeAg-positive CHB patients achieve normalization of transaminases, HBeAg seroconversion, and complete undetectable HBV DNA after one year of NUC treatment, consolidation therapy is continued for at least 3 years, and the re-examination every 6 months remains unchanged. , you can consider stopping taking NUC, and prolonging the course of treatment can reduce recurrence.
Criteria for discontinuation in a specific population with compensated cirrhosis, indefinite treatment is recommended .
Discontinuation of NUC in CHB patients is actually a process that includes pre-discontinuation assessment, implementation of discontinuation, prediction of recurrence, follow-up after discontinuation, and discontinuation of medication Dynamic comprehensive diagnosis and treatment process in multiple stages such as re-treatment. The current discontinuation criteria recommended by various CHB prevention and treatment guidelines still have certain limitations. For patients with a high risk of recurrence, it is still necessary to extend the consolidation course or take the drug for a long time to avoid recurrence after drug discontinuation, leading to liver disease progression, fulminant liver failure and even death.
Suggestion: Unless HBSAg (-) is obtained, or even HBSAb (+) is obtained, drug withdrawal can be considered. At present, sequential long-acting interferon therapy can achieve this goal in some patients.
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