Hepatitis B: Do You Need Yearly Medication After Surface Antigen Negativity?

The term "seroconversion" refers to the transition from a positive to a negative result for the hepatitis B e antigen (HBeAg) or the hepatitis B surface antigen (HBsAg). In this context, "consolidation therapy for one year" typically pertains to the management of hepatitis B infection?

Hello Doctor, four years ago I was diagnosed with acute hepatitis B and started taking antiviral medication (entecavir).
Until January of this year, my HBe antigen turned negative, and my health insurance coverage will expire in January of next year.
Currently, my HBsAg has turned negative, and I have developed HBsAb at a level of 861 IU/L.
After my insurance expires in January, will I need to continue taking medication out of pocket? Since my HBsAg is negative and I have developed antibodies, do I need to consolidate treatment for another year? Thank you.

Xiao Jie, 40~49 year old female. Ask Date: 2019/12/07

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Mr.
Hsiao-Chieh, you can discuss your hepatitis B issue with the physician who prescribed your medication.
According to the health insurance reimbursement criteria, an HBeAg seroconversion cannot be consolidated for one year.
You may want to consult with your attending physician as your medication is nearing expiration.
Thank you for your inquiry.

Reply Date: 2019/12/07

More Info

When it comes to the management of Hepatitis B, particularly after achieving a negative surface antigen (HBsAg) status and the presence of surface antibodies (anti-HBs), the decision regarding the continuation of antiviral therapy can be complex and should be tailored to each individual patient.
In your case, having transitioned from a positive HBsAg to a negative status, along with the development of anti-HBs antibodies at a level of 861 IU/L, is a positive outcome. This indicates that your immune system has successfully responded to the Hepatitis B virus (HBV) infection, and you may have cleared the virus. However, the question of whether to continue antiviral therapy after this point is nuanced.

1. Need for Continued Medication: Generally, if a patient has achieved a sustained response with negative HBsAg and positive anti-HBs, the need for ongoing antiviral therapy is significantly reduced. However, the decision to stop medication should be made in consultation with your healthcare provider, who will consider factors such as your previous treatment history, liver function tests, and any potential risk of reactivation of the virus.
2. Monitoring After Stopping Medication: If you and your doctor decide to discontinue antiviral therapy, it is crucial to have a robust follow-up plan. Regular monitoring of liver function tests and HBV DNA levels is essential to detect any potential reactivation of the virus. The risk of reactivation can vary based on individual factors, including the presence of any underlying liver disease or other risk factors.

3. Duration of Follow-Up: While there is no strict guideline mandating a one-year consolidation period after achieving negative HBsAg, many clinicians recommend continued monitoring for at least a year after stopping antiviral therapy. This is to ensure that the virus does not reactivate and that liver function remains stable.

4. Potential for Reactivation: It is important to note that even after achieving a negative HBsAg status, there is still a small risk of HBV reactivation, particularly in patients with a history of chronic infection. Therefore, your healthcare provider may recommend periodic testing for HBsAg and HBV DNA levels even after stopping medication.

5. Patient Education: Understanding the nature of Hepatitis B and the importance of follow-up care is crucial. Patients should be educated about the signs and symptoms of liver disease and the importance of regular check-ups, even after achieving a favorable response to treatment.

6. Consultation with a Specialist: Given the complexities involved in managing Hepatitis B, it is advisable to have ongoing discussions with a hepatologist or a specialist in infectious diseases. They can provide personalized recommendations based on the latest research and guidelines.

In summary, while achieving a negative HBsAg and positive anti-HBs is a significant milestone in the management of Hepatitis B, the decision to continue or discontinue antiviral therapy should be made collaboratively with your healthcare provider, considering your unique clinical circumstances. Regular monitoring and follow-up are essential to ensure long-term health and to manage any potential risks associated with HBV reactivation.

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