Should You Continue Hepatitis B Treatment After Developing Antibodies?

If you have developed antibodies after taking Huilei (Rituximab), do you still need to pay out of pocket for it?

Hello, yesterday I asked a question.
Four years ago, I had an acute hepatitis outbreak and started taking Hepatitis B medication.
In January of this year, my E antigen turned negative.
Until a few days ago, I paid for a test and found that my HBsAg (surface antigen) is now negative, and I have developed antibodies at 861 IU/L, with no detectable virus.
During my follow-up appointment today, the doctor mentioned that after my health insurance expires in January next year, if financially feasible, I could continue taking the medication out of pocket, and it would be my decision.
I would like to ask if these test results indicate that I am cured, and why I would be advised to continue the medication.
When I asked how long I should continue, he said the longer, the better.
Should I seek opinions from a few more doctors? Thank you.

Xiao Jie, 40~49 year old female. Ask Date: 2019/12/02

Dr. Chen Shidian reply Gastroenterology and Hepatology

After transitioning from a negative to a positive state, it is recommended to maintain a healthy diet for an additional year to consolidate the results.

Reply Date: 2019/12/02

More Info

When it comes to managing Hepatitis B, particularly after achieving a significant clinical milestone such as the development of antibodies and the conversion of HBsAg (Hepatitis B surface antigen) to negative, it is essential to understand the implications of these results and the rationale behind continuing treatment.

Firstly, the presence of antibodies (anti-HBs) indicates that your immune system has successfully responded to the Hepatitis B virus (HBV), which is a positive sign. The fact that your HBsAg is negative and you have a high level of anti-HBs (861 IU/L) suggests that you have developed immunity against the virus. This is generally considered a favorable outcome, as it indicates that the virus is no longer active in your body.

However, the recommendation to continue treatment with antiviral medications such as tenofovir (惠立妥) even after achieving these results can be attributed to several factors:
1. Risk of Reactivation: Hepatitis B can sometimes reactivate, especially in individuals who have previously been infected. This reactivation can occur due to various triggers, including immunosuppression or stress. Continuing antiviral therapy can help mitigate this risk.

2. Long-term Monitoring: Even after achieving a negative HBsAg and positive anti-HBs, regular monitoring is crucial. The liver's health must be assessed periodically through blood tests and imaging studies to ensure that there are no underlying issues, such as liver damage or fibrosis.

3. Duration of Treatment: The duration of antiviral therapy can vary based on individual circumstances. Some guidelines suggest that continuing treatment for at least one year after achieving seroconversion can provide additional protection against potential reactivation. Your doctor’s advice to continue treatment as long as economically feasible aligns with this approach.

4. Individualized Treatment Plans: Each patient's situation is unique. Factors such as age, overall health, liver function, and the presence of other medical conditions can influence the decision to continue or discontinue treatment. Consulting with multiple healthcare providers can provide a broader perspective and help you make an informed decision.

5. Potential for Viral Mutations: In some cases, if treatment is stopped prematurely, there is a risk that the virus could mutate, leading to drug resistance. Continuing treatment may help prevent this scenario.

In conclusion, while your current test results are encouraging and suggest that you have effectively cleared the virus, the decision to continue antiviral therapy should be made in consultation with your healthcare provider. It is advisable to discuss your concerns and the rationale behind the recommendation to continue treatment. Seeking opinions from other specialists can also provide additional insights and help you feel more confident in your treatment plan. Ultimately, the goal is to maintain your health and prevent any potential complications related to Hepatitis B.

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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.

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