Assessing the Need for Continued Antiviral Treatment in Chronic Hepatitis B

Antiviral medications for hepatitis B?

Hello, previously during my hepatitis B flare-up, my GOT and GPT levels were over 1,000, and my viral load was over 1 million.
After taking Baraclude for 14 months, my e-antigen turned negative, and I developed e-antibodies.
The health educator mentioned that after the e-antigen turns negative, I could continue receiving health insurance subsidies for another year, and then I could stop the medication to see how things go.
So far, I have taken Baraclude for 14 months plus an additional 12 months with health insurance subsidies, totaling 26 months.
As I approach the time to consider stopping the medication, all my indices remain normal, except for my HBsAg level, which is nearly 2,000, and I am HBsAb negative.
My viral load is down to 20 copies.
I would like to ask the physician if my current condition meets the criteria for stopping the medication, or if I still need to continue taking antiviral medication out of pocket for a full three years.
Thank you!

A Qiang, 30~39 year old female. Ask Date: 2016/12/08

Dr. Lin Minghui reply Gastroenterology and Hepatology

1) For patients who are HBeAg positive, it is recommended to continue consolidation therapy for at least one year after HBeAg seroconversion.
2) It is best to confirm the absence of hepatitis B virus before discontinuing medication.
3) Health insurance coverage can extend up to three years.

Reply Date: 2016/12/08

More Info

In assessing the need for continued antiviral treatment in chronic Hepatitis B, it is crucial to consider several factors, including the patient's liver function tests, viral load, serological markers, and overall clinical status. Based on your description, it appears that you have been on antiviral therapy (likely with a drug like entecavir) for a total of 26 months, which includes an additional year of treatment after your e-antigen (HBeAg) seroconversion.
The fact that your liver function tests (GOT and GPT) are normal is a positive sign, indicating that your liver is functioning well and that the inflammation has likely subsided. The seroconversion from HBeAg positive to HBeAb positive is also a favorable outcome, as it suggests that the virus is less active and that your immune system is effectively controlling the infection. However, the presence of HBsAg (Hepatitis B surface antigen) and the low level of HBV DNA (20 copies) indicate that the virus is still present in your system.

According to current clinical guidelines, the decision to stop antiviral therapy in patients with chronic Hepatitis B is typically based on the following criteria:
1. HBeAg Seroconversion: You have achieved this, which is a significant milestone.

2. Stable Liver Function: Your liver enzymes are normal, which is a good indicator of liver health.

3. Low or Undetectable Viral Load: While your viral load is low (20 copies), it is still detectable. Many guidelines suggest that a sustained undetectable viral load (often defined as less than 20 IU/mL) is preferable before considering stopping treatment.

4. Duration of Treatment: The standard recommendation is to continue antiviral therapy for at least 12 months after achieving HBeAg seroconversion, which you have done.

Given your situation, it may be premature to stop antiviral therapy entirely, especially since your HBsAg remains positive and your HBV DNA is still detectable, albeit at a low level. The risk of viral reactivation is a concern if treatment is discontinued too early.
In many cases, physicians recommend continuing antiviral therapy until HBsAg becomes negative or until there is a clear indication that the virus is no longer replicating. Some practitioners may also consider the patient's risk factors for liver disease progression, such as age, family history, and any signs of liver fibrosis or cirrhosis.

If you are considering stopping treatment, it is essential to have a thorough discussion with your healthcare provider. They may recommend additional monitoring, such as regular liver function tests and HBV DNA levels, to ensure that your condition remains stable after any changes to your treatment regimen.
In summary, while you have made significant progress in your treatment, the presence of HBsAg and detectable HBV DNA suggests that it may be wise to continue antiviral therapy until further assessments can confirm that it is safe to stop. Regular follow-up with your healthcare provider will help ensure that you make the best decision for your health moving forward.

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