Hepatitis B virus (HBV) infection results in various consequences ranging from asymptomatic state to progressive liver disease, chronic hepatitis, hepatic failure, liver cirrhosis and hepatocellular carcinoma (HCC). Currently available nucleo(s)tide analogue (NA) drugs approved in the treatment, suppress viral replication. Since NAs have little effect on HBV cccDNA synthesis in infected hepatocytes, they do not provide complete cure of HBV infection, and the optimal endpoint of NA therapy, i.e. HBV surface antigen (HBsAg) loss, is rarely achieved. Some of the current HBV management guidelines have begun to consider treatment cessation in selected populations of patients. Concerns regarding treatment cessation include virological and clinical relapse and also the possibility of fibrosis or cirrhosis, hepatic decompensation, liver failure and death. On the other hand, there are some potential concerns about lifelong NA treatment, like side effects on kidneys and bone, increase in the incidence of some chronic conditions such as metabolic syndrome and diabetes mellitus, economic burden to the countries, and possible effects on newborn infants of pregnant women treated with the NAs. So, some unanswered questions remain, namely “in which patients could treatment cessation strategy be effective?” and “what is the optimal time point to perform it?”. The outcome of chronic hepatitis B depends on the equilibrium between HBV and the host’s immune system. In this review, potential immunological and several viral biomarkers for safe NA discontinuation and areas of uncertainty in deciding the best timing to stop NA treatment in chronic hepatitis B is discussed by summarizing the recommendations on actual guidelines. Klimik Dergisi 2019; 32(1): 4-7.
Cite this article as: Tekin S. [When to stop antiviral therapy in chronic hepatitis B]. Klimik Derg. 2019; 32(1): 4-7. Turkish.