Journal ArticleDOI
APASL guidance on stopping nucleos(t)ide analogues in chronic hepatitis B patients.
Jia-Horng Kao,Wen-Juei Jeng,Wen-Juei Jeng,Qin Ning,Tung-Hung Su,Tai-Chung Tseng,Yoshiyuki Ueno,Man-Fung Yuen +7 more
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TLDR
In this article, the authors proposed a very intensive follow-up strategy and identification of low-risk patients for virological/clinical relapse by different biomarkers are the keys to stop the nucleoside analogs (NAs) treatment safely.Abstract:
Chronic hepatitis B virus (HBV) infection is currently incurable. Long-term treatment with potent and safe nucleos(t)ide analogs (NAs) can reduce hepatocellular carcinoma (HCC) and cirrhosis-related complications through profound viral suppression. However, indefinite therapy raises several crucial issues with pros and cons. Because seroclearance of hepatitis B surface (HBsAg) as functional cure is not easily achievable, a finite therapy including sequential 48-week pegylated interferon therapy may provide an opportunity to facilitate HBsAg seroclearance by the rejuvenation of exhausted immune cells. However, the cost of stopping NA is the high incidence of virological relapse and surge of alanine aminotransferase (ALT) levels, which may increase the risk of adverse outcomes (e.g., decompensation, fibrosis progression, HCC, or liver-related mortality). So far, the APASL criteria to stop NA treatment is undetectable HBV DNA levels with normalization of ALT; however, this criterion for cessation of treatment is associated with various incidence rates of virological/clinical relapse and more than 40% of NA-stoppers eventually receive retreatment. A very intensive follow-up strategy and identification of low-risk patients for virological/clinical relapse by different biomarkers are the keys to stop the NA treatment safely. Recent studies suggested that decreasing HBsAg level at the end-of-treatment to < 100–200 IU/mL seems to be a useful marker for deciding when to discontinue NAs therapy. In addition, several viral and host factors have been reviewed for their potential roles in predicting clinical relapse. Finally, the APASL guidance has proposed rules to stop NA and the subsequent follow-up strategy to achieve a better prognosis after stopping NA. In general, for both HBeAg-positive and HBeAg-negative patients who have stopped treatment, these measurements should be done every 1–3 months at the minimum until 12 months.read more
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Journal ArticleDOI
How to achieve functional cure of HBV: Stopping NUCs, adding interferon or new drug development?
TL;DR: In this article , the authors proposed to switch from a NUC to IFN after HBV DNA suppression to increase the chance of HBsAg clearance mainly in those with low HBAg levels.
Journal ArticleDOI
KASL clinical practice guidelines for management of chronic hepatitis B
TL;DR: Erratum to KASL clinical practice guidelines for management of chronic hepatitis B (CHB) as mentioned in this paper [Clin Mol Hepatol 2022;28:276-331] .
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Circulating HBV RNA: From biology to clinical applications
TL;DR: Wang et al. as discussed by the authors reviewed the current knowledge about the molecular characteristics and potential clinical applications of circulating HBV RNA and discussed their biogenesis and the capacity of de novo infection by RNA virions.
Journal ArticleDOI
Hepatitis B
TL;DR: In this article , the hepatitis B virus (HBV) infection is a major public health problem, with an estimated 296 million people chronically infected and 820 000 deaths worldwide in 2019, and Universal infant immunisation, including birth dose vaccination is the most effective means to prevent chronic HBV infection.
Journal ArticleDOI
Clinical Utility of SCALE-B to Predict Hepatitis B Virus Relapse, Hepatitis B Surface Antigen Loss After Antiviral Cessation in Asian Patients After 2-Year Follow-up
Apichat Kaewdech,Suraphon Assawasuwannakit,Pimsiri Sripongpun,Naichaya Chamroonkul,Pisit Tangkijvanich,Teerha Piratvisuth +5 more
TL;DR: At a median follow-up of 2.5 years after discontinuing therapy, HBsAg loss in Thai patients was found to increase over time, and SCALE-B is a valuable tool for predicting CR, VR, and HBs Ag loss; HBV RNA is not significantly associated with long-term outcomes.
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