I found I had Hepatitis B since 1998, before 2010 I did not take antivirals medicine, since 2010 I have taken antivirals because my HBV DNA is quite high, since then my doctor said I cannot not stop or reduce the medicine. Recently my blood work showed HBsAg became negative, but HBeAg still is negative ( I tested twice), my doctor said I need continue to have Vemlidy (25mg/day) until HBeAg become positive.
has someone also have such case? are there cases that HBeAg become positive? when I can stop to take Vemlidy?
Wow - that’s so good to hear that you could seroconvert on treatment! Can I ask how you got infected - was it from birth? HBeAg-ve means low viral replication. I’m not sure why your doctor would advise to continue treatment until HBeAg becomes positive as this would mean high viral replication - maybe he/she meant HBe AB not Ag?
I cannot comment on your particular case, but I can note that determining when someone can stop taking nucleos(t)ide analogs such as entecavir and tenofovir is a very active clinical research question. This is complicated because we don’t know enough about how HBV is cleared by therapy, and that the patient population taking nucleos(t)ide analogs is very diverse. What is OK for one person might not be OK for another, and we don’t know how to tell the 2 groups apart. Also, the answer might be different in the future depending on what type of new therapies get approved.
Sorry for the unsatisfying answer, but this is a really hard question to answer.
Hi; Thomas, Kimbopumpkin, and John
Thank you very much for your comments.
I do not know how I got infected, but it was not from birth. First time test result was from 1998, HBsAg+, HBsAB QL-, HBeAg-, HBeAB+, HB core AB total+; that time I did not know if there were test iterm on HB virus DNA; my liver function were all normal. I did not take any antivirus medicine; then in 2006, in addition to HBsAg test (which was positive), my doctor gave me a test of HB Virus DNA (3600). My doctor did not suggest I should have antivirus medicine. In 2010 I tested HB virus DNA 19755 (IU/ml) 114974 (copies/ml) . I started to have Vread, after I had Vread for three months, HB virus became normal. My liver function were all normal (every year I tested at least 2 times); HBsAg and HBeAB were always tested positive; and HBsAB QL and HBeAg were always negative; Recently HBsAg tested become negative, My doctor wants me to test HBs AB QL become positive (not HBeAg).
For myself I would not stop treatment. I wouldn’t feel like I was protecting my liver.
Treatment has been around for a long time. And proven safe.
Is there prove, trails done saying it’s safe to stop?
Even if there was, I still wouldn’t stop. Taking one tablet a day, that does make you feel sick, is not hard for me and makes me feel I am doing the very best for my liver.
My sibling doesn’t get monitored either. I’ve tried telling her how deadly this disease is to no avail
Thanks for also sharing your experience @Caraline.
As a person with lived experience (Hep B since birth) but also medical background (in psychiatry), my view on medication is a bit skewed as I tend to see and fear the long-term effects of medication on patients albeit they are antipsychotic medications not anti-viral - I am still fearful of the long-term unknown effects of taking medication in general and the idea of taking something without being able to stop does worry me. Currently I am not on treatment but like everyone else we still live in hope of one day being able to somehow magically get rid of this infection!
I am not a doctor, but I read that the current guidelines are that you may be able to stop antivirals if you maintain HBsAg- for 6 months. So I would say, get tested again in 6 months, and if you are negative, have the discussion with your liver specialist about stopping treatment. I agree that it would be a good idea to get your HBsAb quant levels checked. Although this is not a requirement for the definition of functional cure, data does show that people with higher levels of antibodies are less likely to relapse off of treatment.
Hi @bz1992uk,
I agree with @et5656. The current recommendation for treatment cessation is the successive negative surface antigen test for 6 months or longer, normal liver imaging, and LFTs. So, the focus is not only on surface antigen seroconversion but on the other liver tests taken as a whole. There is no mention of normal liver imaging and LFTs in your message. That is something to be considered as well, not just the surface antigen results. Patients with functional cure through therapy may not develop antibodies, making it impossible to measure, even though HBsAg is negative.
@kimbopumpkin, your concerns and fears are valid. As we know, treatment is not for every HBV patient. Adherence is a crucial aspect of therapy; therefore, having a continued conversation with one’s provider before and during treatment is vital. I am not aware of any current research that shows any negative long-term effects of the current antivirals. But I do agree that we need to understand the long-term impacts, especially for HBV treatments, which can be lifelong.
Personally, I don’t think much about that, nor has the thought crossed my mind, because I assume the effects of HBV are probably worse than those of the medication (long-term). I have seen and witnessed firsthand what HBV does to people who had no chance of survival, and it is not something I want to experience.
I see, the anti-HBs antibody just gives that extra insurance that the HBsAg will stay negative - this is most likely the rationale that your health provider is taking.
Hi, @ThomasTu
Thanks for additional nice suggestions and comments, I will have HBsAg test in 6 month, if the HBsAg still stay negative, I will possibly stop Vemlidy
Hi, @Bansah1
My liver function tests and liver US tests were all normal in past more than 20 years, Thanks