When to stop treatment

@ThomasTu @availlant @HealthExperts
Can I stop medications after two months due to financial problem?
Here are my lab results
Alk phos:159.5…(40-170)IU/l
Total bili:1.33…(0.2-1.0)mg/dl
Conj bili1.1… …(0-0.3)mg/dl
Unconj bili:0.23………(0-0.8)mg/dl
A/G ratio:1.18…(1.5-2.5)
HBsAg: positive
HBsAb: Negative
HBeAg: Negative
HBeAb: positive
HBcAb: positive
Normal abdominal scan

HBsAg levels are missing, viral genotype is missing, all the baseline features are missing. Why did you start NA ?



Prof. Pietro Lampertico, MD, PhD

Full Professor of Gastroenterology

Head of Gastroenterology and Hepatology Division

Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico

University of Milan

Via Francesco Sforza 35

20122- Milan


Phone +390255035432

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Email pietro.lampertico@unimi.it



This are only the test I did,and the doctor recommended treatment

Dear @Godsown,

It is difficult to say whether it is safe to stop medications and you must do so with guidance and monitoring from your doctor. In some cases, stopping medications can be dangerous and lead to severe liver injury.

I am not sure where you are based, but it may be worth reaching out to local advocacy groups to see if there are other cheaper approaches to getting the medications you need.



Thanks for always being there for us.God bless you all.can I be taking only tdf for now (i.e) no test after six month or yearly till I get financial stable to minimize the cost?

Dear @Godsown,

I think that this is a complicated decision that you need to discuss with your health professional.



I can’t get a hepatologist now, even if I do the cost is still another thing.what I intend to do is taking tdf the doctor prescribed appropriately and doing Lft and ultrasound once in a while

Hi @Godsown,

While this is likely a less-risky approach than stopping treatment altogether, it is worth talking to your doctor about your financial concerns and your plans. The benefits are: 1) they can warn you if this is an unsuitable approach given your total medical history; 2) they may be able to advise you on alternatives or local groups who could help. Keeping communication open is key for ongoing monitoring.

Hope this helps,

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Good morning, i discontinue tenofovir after three years on my own because i could not afford to continue the treatment…how dangerous is this…my recent ultrasound and lft all good… I am HBEAG negative

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Entecavir is often much cheaper than tenofovir, and very effective. Have you looked into entecavir?

Dear @Mohammed,

Stopping antivirals on your own does carry risk of reactivation of the virus and severe liver damage (sometimes leading to death), even if your liver is healthy at the moment. It is not something you should decide to do on your own. Indeed, there are alternatives you can discuss with your doctor such as switching antivirals as @elderberryblu has suggested.



From the beginning i was not supposed to be on anti viral my viral load was hus 28 when my doctor put me on antiviral…i honestly don’t want to go back on antiviral but i will be monitoring my viral load after every four month and liver function test every month. Ultrasound yearly…if there is need for me to restart the medication i will…most Nigeria doctors don’t have knowledge of hepatitis b just wrongly putting people on antiviral…some will ask you to take it for just six months and stop…


Same thing with me brother.i was not supposed to be on arvs when the doctor put me.how can you trust somebody with something when they don’t really know about it.God save us in nigeria.mohammed can we connect please?


In this part of the world where I stay, most of the Doctors don’t really know about hep b, secondly they will want to take advantage of you,they only care about the money.i’m a very healthy adult.No offense sir.

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I’m not saying in Australia is the same but I don’t trust the doctor either. I’ve come to realise they are not God. I do my own research and make a decision from that.
Most of the time they are right but sometimes I’ve been given pills for a disease I didn’t have .
Going off the antiviral is dangerous. It should even be taken at the same time every day.
With Hep B there are no symptoms. Your liver could be inflamed, cancerous, sick and you wouldn’t know or be in pain until it may be too late, for treatment. A silent killer.
Please take care :hugs:

I have six monthly blood tests and ultrasound so twice a year. I get tested and that’s all.
You seem to be getting tested a lot. Maybe you could save costs and only getting tested twice a year

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Dear @Godsown and @Mohammed,

I’m sorry to hear of such conditions and that the health care systems are not trustworthy in your country.

It still stands that on stopping therapy, you risk severe hepatic flare and potentially liver failure. At the moment, we cannot predict who this will happen to. A meta-analysis has shown that this is around 1% (Serious adverse events after cessation of nucleos(t)ide analogues in individuals with chronic hepatitis B: A systematic review and meta-analysis - ScienceDirect), but this probably underestimates the rate because many people in these studies may be retreated to prevent severe flare and liver failure.

There should be close monitoring after stopping treatment; most papers I have found recommend testing every month for the first 3 months and then 3 monthly for the first year.

Current guidelines suggest the following criteria for stopping treatment:

  • NAs should be discontinued after confirmed HBsAg loss, with or without anti-HBs seroconversion
  • NAs can be discontinued in non-cirrhotic HBeAg-positive CHB patients who achieve stable HBeAg seroconversion and undetectable HBV DNA and who complete at least 12 months of consolidation therapy. Close post-NA monitoring is warranted.
  • Discontinuation of NAs in selected non-cirrhotic HBeAg-negative patients who have achieved long-term (>3 years) virological suppression under NA(s) may be considered if close post-NA monitoring can be guaranteed.

I hope this provides you with the information you need.



Hi Godsown
Sorry for finding yourself here.
My reading of your text informs me that you met all the parameters of starting treatment and so you doctor initiated the same. Moreover, your intent to stop treatment is informed by financial scarcity. I recommend you reach out for drugs provided in Africa for free as ARV’s for AIDS treatment that has a combination of TDF/3TC and am sure it will help you rather than being on no medication.
Please let us know your progress.


Who do I ask?i don’t know is simply the answer.They doctor put me on tenofovir immediately I was diagnosed with hbv.He instructed that I should take the pill for six months after which I go for hbv DNA test then we can decide weather to stop or not.i’m just tired.

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Dear @Godsown,

Undetectable HBV DNA is not a sole indication to stop treatment, and can be very unsafe: the virus infection can reactivate and cause serious liver damage.


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