Dear participants in this thread,
I know that all this discussion about discontinuation of antiviral therapy has me quite concerned and I suspect Thomas as well.
As Joan very rightly put it, taking a pill once a day is a small burden and keeps you safe from your chronic HBV infection.
Lets get some facts out plainly on this thread for the benefit of everyone.
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HBV DNA undetectable and normal ALT are NOT ACCEPTABLE OR SAFE conditions for stopping therapy with any NUC, this includes the following:
lamivudine (aka 3TC / Epivir)
adefovir dipivoxil (aka ADV, Perveon, Hepsera)
entecavir (aka ETV, Barraclude)
tenofovir disoproxil fumarate (aka TDF, Viread)
tenofovir alafenamide (aka TAF, Vemlidy) -
The only acceptable criteria for stopping NUC therapy is the clearance of HBsAg (a “negative” result by a qualitative assay or < 0.05 IU/mL by a quantitative assay). This should be preferably established with at least one repeat measurement spaced three months apart. This is the current guideline for stopping NUC therapy in North America and Europe. If your physician thinks it is ok to stop your NUC therapy without establishing these clear criteria, I strongly recommend you find another physician (preferably a gastroenterologist / hepatologist).
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There are some clinical studies where the withdrawal of NUC therapy has been attempted with “low HBsAg” but it is important to note that this clinical activity is being performed under frequent and intense monitoring by expert hepatologists The results of these studies have not been conclusive and should not be used by patients or physicians to guide treatment with NUCs.
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The only instance where NUC dose modification is indicated is for ETV and TDF in the case of impaired kidney function (measured by elevated creatinine levels in the blood / reduced creatinine clearace rate). For ETV this is reduction of the daily dose and for TDF this is switching the dosing regimen from 300mg daily to 300mg every other day. There is no current dose reduction indicated for 3TC, ADV or TAF. Dose alteration of ETV and TDF should only done under the supervision of a qualified physician and should not be done for other NUCs including TAF.
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The danger with stopping NUC therapy inappropriately or altering NUC dosing on an adhoc basis is very real and significant. Reactivation of active HBV infection can occur quite rapidly and can lead to a fulminant hepatitis where liver function decompensates very rapidly. You may feel fine during the early stages of this dangerous event and come to see your doctor only after significant liver damage has occurred which may be difficult to reverse, even with resumption of NUC therapy.
A lot of time and hard work by 1000’s of researchers and physicians has gone into carefully creating treatment guidelines for your benefit, please follow these guidelines!
Best regards to everyone…