Do I Need to Continue Taking Antiviral Medication After Developing Hepatitis B Antibodies?

If you have developed antibodies against hepatitis B, do you still need to continue taking Hepatitis B immunoglobulin (HBIG) for a period of consolidation?

Hello, four years ago, I started taking antiviral medication (Hepatitis B treatment) due to an acute flare-up of Hepatitis B, which resulted in elevated levels.
Until early January of this year, my E antigen turned negative, and I continued with consolidation therapy.
During a recent health check, it was found that my HBsAg level is 0.41 COI, which has turned negative, and I have developed antibodies at a level of 861 IU/L.
Given this situation, how long should I continue taking the antiviral medication? Should I wait until the antibody levels are higher before stopping the medication to reduce the risk of relapse? Thank you.

Xiao Jie, 40~49 year old female. Ask Date: 2019/12/01

Dr. Chen Shidian reply Gastroenterology and Hepatology

The principle is to continue treatment for an additional year to consolidate the results.
You have developed antibodies, and it is unlikely that you will experience a recurrence after stopping the medication, but please continue to have regular follow-ups.

Reply Date: 2019/12/01

More Info

When it comes to managing chronic Hepatitis B, the decision to continue or discontinue antiviral medication, such as Entecavir (also known as 惠立妥), is nuanced and should be based on several clinical factors. In your case, you have made significant progress: your HBeAg has turned negative, and you have developed a substantial level of antibodies (861 IU/L). This is indeed a positive sign, indicating that your immune system is responding well to the virus.

Generally, the management of Hepatitis B involves monitoring several key markers, including HBsAg (Hepatitis B surface antigen), HBeAg, and HBV DNA levels. In your situation, the fact that your HBsAg is now negative (0.41 COI) is encouraging. According to current guidelines, if a patient has a negative HBeAg and has developed antibodies, the next step is often to continue antiviral therapy for a period of consolidation, typically for at least six months to a year, to ensure that the viral load remains undetectable and to minimize the risk of relapse.

The rationale behind continuing antiviral therapy even after the development of antibodies is to ensure that the virus is fully suppressed and to prevent any potential rebound in viral activity. While your current antibody levels are promising, it is not uncommon for patients to experience fluctuations in their immune response. Therefore, it is advisable to continue monitoring your liver function and viral markers regularly.

In terms of whether you should wait for your antibody levels to increase further before stopping the medication, it is essential to understand that the presence of antibodies alone does not guarantee that the virus is completely eradicated or that it will not reactivate. The decision to stop medication should be based on a comprehensive evaluation of your liver health, including liver function tests and possibly imaging studies, rather than solely on antibody levels.

Moreover, it is crucial to have regular follow-ups with your healthcare provider. They will likely recommend periodic blood tests to monitor your liver enzymes (ALT and AST), HBV DNA levels, and other relevant markers. If you were to stop the medication, your doctor would want to ensure that you are closely monitored for any signs of viral reactivation.

In summary, while your progress is commendable, it is generally recommended to continue antiviral therapy for a period of consolidation after achieving negative HBeAg and positive antibodies. The exact duration should be determined in consultation with your healthcare provider, who will consider your overall health, liver function, and any potential risks of stopping the medication. Regular monitoring will be key to ensuring your long-term health and preventing any complications associated with Hepatitis B.

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