Stop taking- Entecavir

Dear all,
A couple days before I conducted a routine screening of my Hepatitis B status (lab results are attached). The viral load (quantitative DNA) or PCR is “not detected”. After seeing my lab result along with the PCR result, the doctor told me to stop taking Entecavir for one month. He said after one month we will reassess, if the viral load was still “not detected” then we will conduct another PCR after 3 months, if it was still “not detected” then will conduct PCR after 6 months and will continue so on. My question is that, if I quit taking Entecavir, will a relapse occurred? If occurred, will Entecavir suppress the virus again?
Lab results

Background information:

  • I was diagnosed in 2014 by chance with chronic Hepatitis B, with viral load (PCR) 38,000,000 IU/ml
  • The doctor put me on Lamivudine
  • After six month the PCR result was “not detected”. The PCR result is “not detected” up to now.
  • After that the doctor switched me from Lamivudine to Entecavir. I am taking one 0.05mg pill of Entecavir from 2014 till now.
  • My blood pressure is always high like 140/90 sometime 130/85, but I am not taking any medicine for it.
  • I have a poor sleep

I am looking forward for your kind advice!
Wardak

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Were you tested for HBsAg level (quantitative)? There is some research with preliminary outcome that stopping antiviral with low levels of HBsAg (below 100) might lead to a cure in some patients. But results are still inconclusive.

Some better educated ones might comment here!

Dear @wataru,

Yes, the guidelines suggest that if you remain HBV DNA negative for a long time on antivirals (>3 years), you can consider removing antivirals to see if your immune system will continue the suppression (and also have the chance of undergoing HBsAg seroconversion).

As @mantana has mentioned, the chance of HBs seroconversion is more likely if your HBsAg levels are lower.

Hope this helps,
Thomas

Hi Wardak,
I have heard what your doctor told you. I have also read what @Thimas has written. Unlike them, I am concerned about your total, direct and indirect billirubin. They suggest your liver is not working as well as it should. Would you mind doing ultrasound examination?
Kinoti

The best marker for discontinuation right now is HbCrAg. If you have access to it you should give it a try. HbsAg and DNA some time get low but raise quickly after discontinuation, like in my case.

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Dear @apatient ,
Thanks a lot! I will discuss this with my doctor but as far as I know we may not have access to it here in Afghanistan. Again, thanks for your time!

Dear @Kinoti,

Thank you so much for reading my post as well as providing the excellent advice! I have conducted a Doppler ultrasound which also included my liver assessment, the result was normal but I don’t trust it when it comes to my liver status’ assessment. So I will conduct an ultrasound and will share the result for your kind review.
Best regards,
Wardak

Dear @mantana,
Thanks a lot for your time to read my post/question! No I was not tested for HBsAg level (quantitative), I hope this test can be doable here in Afghanistan. So I will discuss with my doctor and will share the result here.
Best regards,
Wardak

Dear @ThomasTu,

Thank you so much for taking the time to read my post! I haven’t tested for HBsAg level, I will test for it as well and share the result here for your further kind advice. However, my concern is that, if I quit taking Entecavir and if relapse occur, will Entecavir suppress the virus again?

Best regards,
Wardak

1 Like

Good question, in all the studies I’ve seen, ETV and TDF are still effective in suppressing the virus after stopping and starting again.

Thomas

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Dear @ThomasTu,

Thank you so much for the promising answer!
Best regards,

1 Like

Hi Wardak,
I agree with @thomas on the efficacy of TDf and entecavir on suppressing hepb virus after starting and stopping. Your note is, if you must stop medications keeping closely monitored yourself is crucial to avoid sudden liver failure due to unchecked relapse.
Kinoti

2 Likes

Dear @Kinoti,

Thanks a lot for the valuable advice! much appreciated!

Best regards,
Wardak

Dear @apatient,

Were you able to suppress the virus again?

Thanks in advance!
Wardak

I don’t know yet. It’s be a few months until my next appointment

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Dear Wardak,
The important thing is that you need to test HBsAg. If HBsAg doesn’t be detected, you need to test HBcrAg, HBV RNA levels as well. After that, if HBcrAg and HBV RNA can’t be detected, I think you can stop Entecavir.
Another method is that if HBsAg can’t be detected for 2 years, then you test HBcrAg and HBV RNA, both of them are negative, it is the time that is much safer to stop entecavir.

Best regards
Yuanyuan

Hi @yuan
You have introduced me to a new terminology hepb RNA since I have always known hepb to be a DNA desease and not RNA like hepb c.
Kinoti.

FYI, both HBcrAg an HBV RNA are not widely available tests, so it is difficult to get access to them unless part of a trial. These are currently under investigation as to exactly how useful they are in predicting things such as viral reactivation after stopping antivirals.

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Hi, While completely clearing the virus may not happen for many people who stop antivirals after years of treatment, it does seem that many can go for years without any flare ups. The key is to keep monitoring, frequently at first and then every 6 months.
My sister and I have both had HBV from birth, we’re both on antivirals for about 10 years, then stopped ( she was enrolled in an early study to see what would happen with stopping the meds). We have both been in “remission” (normal liver enzymes and barely detectable viral DNA) for 7 and 8 years respectively now. I think it’s definitely worth trying to stop treatment, especially when e antigen is negative.

Hi @Karin,

Yes, there have been a few studies to see if this is possible for people who have taken antivirals for many years. However, there are a few people for whom this is very dangerous and it can lead to severe liver damage because the virus comes back so quickly. It is very important to do this with very close monitoring from your doctor.

I just want to stress how important it is for people not to stop antiviral medications on their own without their doctor’s advice.

Thomas