Managing Medication for Chronic Hepatitis B: To Continue or Not? - Gastroenterology and Hepatology

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Managing chronic hepatitis B can be a complex decision, especially when it comes to the use of antiviral medications like Entecavir (干安能). Your situation, where you have been on treatment for a year and a half with persistent e-antigen positivity and elevated liver enzymes (GOT and GPT around 200), raises important considerations regarding the continuation or cessation of therapy.


To Continue or Not?
1. Understanding e-Antigen Positivity: The presence of e-antigen (HBeAg) indicates active viral replication and a higher likelihood of liver inflammation. In your case, since HBeAg is still positive, it suggests that the virus is still active, and continuing antiviral therapy may be warranted to suppress the viral load and prevent further liver damage.

2. Risk of Drug Resistance: One of the concerns with long-term antiviral therapy is the potential development of drug resistance, especially if the virus is not adequately suppressed. If you were to stop treatment and the virus remains active, there is a risk that it could mutate, leading to resistance to the current medication. This could complicate future treatment options, including the use of interferon therapy.

3. Monitoring and Observation: If you and your healthcare provider decide to stop treatment, it is crucial to have a robust monitoring plan in place. Regular blood tests to check liver function and viral load will help determine if the virus is becoming more active. If liver enzymes continue to rise, it may indicate that the virus is replicating more aggressively, necessitating a return to antiviral therapy.

4. Interferon Therapy: If you develop drug resistance or if your liver function deteriorates, interferon therapy could be an option. However, interferon is not suitable for everyone, and its effectiveness can vary based on individual factors, including the specific characteristics of the virus and the patient's overall health.

5. Consultation with Specialists: Given the differing opinions among your physician friends, it may be beneficial to consult with a hepatologist or a specialist in infectious diseases who has experience managing chronic hepatitis B. They can provide insights based on the latest research and guidelines, helping you make an informed decision.


Conclusion
In summary, the decision to continue or stop antiviral therapy for chronic hepatitis B should be made collaboratively with your healthcare provider, considering your specific circumstances, the potential risks of drug resistance, and the importance of ongoing monitoring. If you choose to continue treatment, it may help to stabilize your liver function and reduce the risk of complications such as cirrhosis or liver cancer. If you decide to stop, ensure that you have a clear follow-up plan to monitor your liver health closely.

Ultimately, the goal is to maintain liver health and prevent complications while balancing the risks associated with long-term medication use. Regular communication with your healthcare team and adherence to monitoring protocols will be key in managing your condition effectively.