Evidence-Based Management of Oral Nucleos(t)ide Analogue Withdrawal in Virally Suppressed Patients with Chronic HBV Infection

AbstractPurpose of ReviewThe strategy of finite Nuc therapy has been increasingly accepted globally. How to manage Nuc withdrawal in HBV-suppressed patients has become an important issue. This review aimed to provide an evidence-based approach.Recent FindingsHBV suppression may sustain after Nuc cessation at an incidence the higher the lower the end of therapy HBsAg level. Clinical relapse and hepatitis flare may occur after Nuc cessation at a 2-year incidence of 60% and 42%, respectively. Timely retreatment may prevent/rescue deterioration to hepatic decompensation albeit at an incidence of almost 0 in non-cirrhotic patients, whereas “no retreatment” is an important factor for HBsAg loss.SummaryProper monitoring after Nuc cessation is crucial for timely retreatment to ensure safety. No retreatment or not too early retreatment may allow further host immune clearance response for HBsAg decline toward HBsAg loss. Proper utilization of biochemical criteria, especially combined HBsAg/ALT kinetics, may help proper retreatment decision.
Source: Current Hepatitis Reports - Category: Infectious Diseases Source Type: research