When to Stop Antiviral Therapy in HBeAg-Negative Patients with Chronic Hepatitis B?

The strategy of finite nucleos(t)ide analogue (Nuc) therapy in HBeAg-negative patients has been increasingly accepted globally, and when to stop therapy has become an important issue. This review aimed to address this issue.

The incidence of off-therapy relapse is lower with lower end-of-therapy (EOT) HBsAg level. Pretherapy HBV DNA < 20,000 IU/mL, on-treatment HBV DNA undetectable by week 12, treatment duration > 3 years, on-treatment HBsAg decline > 1 log₁₀ IU/mL, and EOT HBsAg < 100 IU/mL are also factors for increasing off-therapy HBsAg loss. Off-therapy hepatitis flare may occasionally deteriorate to hepatic decompensation, which can be prevented/rescued by timely retreatment whereas “no-retreatment” is an important factor for HBsAg loss.

All patients meeting recommended stopping criteria are eligible for Nuc withdrawal. The favorable factors for low relapse rate and high HBsAg loss rate can be used to encourage patients to stop Nuc therapy and adhere to off-Nuc monitoring plan.