Stopping long‐term treatment with nucleos(t)ide analogues is a favourable option for selected patients with HBeAg‐negative chronic hepatitis B

Abstract

The immune response against the infection is impaired in patients with chronic hepatitis B, and although HBV DNA can effectively be suppressed by nucleos(t)ide analogues (NA), durable immune control is only established in a minority of patients. This especially applies in HBeAg‐negative patients who usually must receive lifelong NA treatment. Calculated withdrawal of NA leads to a relapse of HBV DNA in most patients. There is evidence that this sudden exposure of viral antigens can trigger immune control in some patients which may result in HBsAg loss or a form of immune control, then sustained low HBV DNA levels and normal alanine aminotransferase (ALT). In the first prospective randomized trial investigating tenofovir treatment cessation in HBeAg‐negative patients, most patients did not need retreatment after NA cessation, although all patients showed a transient relapse in HBV DNA. HBsAg loss was identified in almost 20% nearly 3 years after stopping NA. Further confirmation of these findings is needed in larger randomized trials and patients who are most likely to benefit from finite therapy must be identified to individualize NA stopping strategies. However, these results suggest that in patients without risk factors such as cirrhosis or other severe conditions, NA treatment may be stopped, as long as adequate safety rules for retreatment are followed.

 

KEYWORDS
HBV, immune control, treatment cessation, withdrawal

 

About Speaker

Thomas BERG

Germany

Contact: leber@uniklinik-leipzig.de


Biography of Thomas BERG

Professor Dr. Thomas Berg completed his medical training at the Universities of Tübingen, Freiburg and Berlin, Germany. He specialized in internal medicine in 2001 and in Gastroenterology and Hepatology in 2007 at the University Medicine Berlin, and became a lecturer in this subject in 2002.
In 2002, Professor Berg took up the position of Associate Director and Professor of Medicine at the Department of Hepatology and Gastroenterology of Charité, Campus Virchow-Clinic, University Medicine in Berlin, where he was Head of the Liver Out-Patient Clinic and the Laboratory for Molecular Hepatitis and Viral Diagnostics.
Since December 2009, he has been the Head of the Section of Hepatology at the University Hospital in Leipzig, Germany, and since October 2018 acting Director of the Clinic of Gastroenterology at the University Hospital, Leipzig.
His clinical and translational research is focused on chronic viral hepatitis, liver transplantation, hepatocellular carcinoma, genetics in liver disease, and liver failure, and he participated in numerous national and international clinical trials.
He is Vice Secretary of the European Associations for the Study of the Liver (EASL), Board member of the EASL International Liver Foundation (EILF) and Co-Editor of the Journal of Hepatology since 2014.
He is also member of the American (AASLD), European (EASL), and German (GASL) Associations for the Study of the Liver, The European Society for Organ Transplantation (ESOT), The European Liver and Intestine Transplant Association (ELITA), German Transplantation Society (DTG), Working Group Internal Oncology (AiO), Working Group Gastroenterological Oncology (AGO), German Cancer Society (DKG), German Society of Gastroenterology (DGVS), and the representative of the DGVS in the foundation council of the German liver foundation. He has published more than 350 articles in peer-reviewed journals and more than 100 reviews and textbook contributions. His h-index is 72 (Scopus).

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