Evidence-Based Approach to Stopping Oral Antiviral Therapy in Chronic HBV
AbstractPurpose of ReviewTo review the evidence for stopping antiviral therapy with nucleos(t)ide analogues (NA) in patients with chronic hepatitis B.Recent FindingsHBsAg loss is usually stable even without anti-HBs seroconversion after stopping NA therapy. About 50% of HBeAg-positive patients who have achieved anti-HBe seroconversion and have stopped NA therapy remain in virological remission. Consolidation therapy increases the response rate. In HBeAg-negative hepatitis, stable virological remission is documented in 30% after NA discontinuation. Interestingly, some studies document unexpectedly high long-term HBsAg loss rates after stopping therapy.SummaryEvidence supports NA discontinuation, especially after HBsAg seroclearance. In HBeAg-positive patients, NA can be stopped 12 months after anti-HBe seroconversion but severe flares have to be considered. NA discontinuation is also possible in selected HBeAg-negative patients if close monitoring can be guaranteed. The high rate of HBsAg loss needs further evaluation.
Publication date: November 2020Source: Antiviral Research, Volume 183Author(s): Juan Manuel Battagliotti, Diego Fontana, Marina Etcheverrigaray, Ricardo Kratje, Claudio Prieto
Condition: HBeAg Positive Chronic Hepatitis B Intervention: Drug: NAs+IFN-α Sponsor: Beijing 302 Hospital Not yet recruiting
CONCLUSIONS: HBV reactivation is a rare event in patients treated with a bDMARD and it can also occur while taking lamivudine, not only in chronic carriers (as per the literature data) but also in inactive ones. Regular screening followed by prompt treatment can prevent symptoms or complications. Due to the risk of hepatitis following the immune reconstitution, an antiviral therapy should be considered in the case of sudden discontinuation of csDMARDs or bDMARD. PMID: 32940216 [PubMed - as supplied by publisher]
AbstractPurpose of ReviewThe burden of chronic hepatitis B (HBV) remains disproportionately high among people living with HIV (PLWH) despite the advent of HBV vaccination and HBV-active antiretroviral therapy (ART). This review summarizes new insights and evolving issues in HIV-HBV coinfection.Recent FindingsHBV-HIV coinfection is still a leading cause of cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality more than a decade after the approval of tenofovir. While tenofovir-based ART has been shown to improve rates of HBV virologic suppression and halt fibrosis progression, the long-term benefits on the p...
It is unclear if anti-hepatitis B virus (HBV) treatment can eliminate incident hepatic decompensation. Here we report the incidence and predictors of hepatic decompensation among cirrhotic patients receiving antiviral therapy for chronic hepatitis B.
Publication date: Available online 28 August 2020Source: Antiviral ResearchAuthor(s): Senko Tsukuda, Koichi Watashi
Conclusion: Asthenia, anorexia, and jaundice during mid-late pregnancy should be immediately investigated. Before and during the pregnancy, hepatologists or obstetricians should actively screen pregnant women with CHB for HBV DNA status and alanine aminotransferase levels. Reactivation of HBV replication in pregnant women with CHB may lead to ACLF, especially in multiparous women. Once ACLF is diagnosed, antiviral therapy should be considered as soon as possible to protect maternal and fetal health. PMID: 32849869 [PubMed]
Of the 414 074 CHB patients, 22.9% had regular follow‐up. Regular follow‐up was independently associated with decreased risk of liver cancer mortality compared to no follow‐up (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.50‐0.63,P