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
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
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
I don’t know yet. It’s be a few months until my next appointment
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.
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
My doctor had me monitor every two weeks at first, for 2 months then every month, then every 3 and after the first year I was back to the standard 6 month intervals. From the results of the StopNuc study my sister was enrolled in, they really didn’t see the dangerously high viral rebound. I’m not saying it can’t happen but I think the concern about this has been overstated and has led to many people being afraid to get off treatment, and staying on antivirals much longer than necessary. For many it‘s possible to be off meds for periods of 2- 5 years and beyond without viral rebound, and usually if it starts multiplying again it’s a slower process that will be detected in time with routine monitoring.
I do wonder what role the e- antigen status and also the type of mutation play in the outcome of stopping treatment, and I think we need more research on this.
Given the still quite high cost of ongoing treatment, as well as the side effects of at least some antivirals, I think it’s important for people to be aware that for many, if not most, lifetime treatment is not the absolute necessity we were told it was when these meds first became available for HBV.
Yes, there are many studies looking into this (many are summarised here: Challenges With Stopping Long-term Nucleos(t)ide Analogue Therapy in Patients With Chronic Hepatitis B), in some studies 80% respond as you have with “sustained virological response”. However, in other studies 0% responded like this.
We are still working out what factors might be responsible for this. We have some general preliminary observations and sort of see that it’s less likely you will respond well if you have high HBsAg or HBeAg-postive, if you’re Asian, or have cirrhosis.
There’s also the risk of adverse outcomes like liver failure or death: there was one study where 4% of people who stopped nucs had liver decompensation. This is why it’s very important to have very close monitoring during and ongoing monitoring in the years after the discontinuation.
Hello I’m a new member I have registered few months a go I’m a chronic hepatitis b patient I was diagnosed last year during my pregnancy and since then I started this journey it wasn’t easy for me I couldn’t believe I had it I cried my eyes out but I later accepted it.
I have been monitoring my my liver and viral load since I gave birth and my doctor recently requested I go for fribroscan and it showed I have stage 1 frobrosis I started taking tenofovir last two weeks and I just found out I’m pregnant please I’m scared should I continue the treatment or I shout stop I heard tenofovir disproxil fumarate has effects on pregnancy
Hi @sadia,
Welcome to the forum and sorry to hear about the stress you’ve been under about your diagnosis. It is good that you are seeing a doctor about it though and it got caught before too much liver damage had occurred.
Regarding your question, you need to talk to your doctor before changing anything about how you take your medications. However, tenofovir is considered safe and is the recommended antiviral for those who are pregnant (e.g. see the guidelines from the Gastroenterological Society of Australia, recommendation 22 - https://www.gesa.org.au/public/13/files/Education%20%26%20Resources/Clinical%20Practice%20Resources/Hep%20B/HBV%20consensus%20Mar%202022%20Updated.pdf#page=14).
Thomas
Thank you for the feedback
But can I continue taking it even in early pregnancy without causing any effects on the fetus?
And please in my case is the the fibrosis reversible?
Hi @sadia,
Multiple studies have shown that there is no increased risk to the safety of mother or child when taking tenofovir early in pregnancy:
Also, F1 fibrosis is generally considered to be reversible.
Hope this helps,
Thomas
Please is it true that tenofovir DF causes birth defects and stillbirth please I need more information about it I read it online I’m scared because I’m currently pregnant and I’m taking tenofovir df o was on medication when I got pregnant so my gastroenterologist said must continue because discontinuation can cause hepatic flare I’m scare I don’t want to lose my child 
Dear Sadia,
As mentioned above, there is no reported risk for birth defects and stillbirth associated with tenofovir. This is the recommended treatment for HBV in pregnant mothers because of this safety aspect. Indeed, it will help ensure that your child is protected from HBV upon birth.
Thomas