在肝硬化患者中,EASL 和 AASLD 均建议无限期长期治疗,而 HBsAg 持续阳性[7,8]。另一方面,APASL 是唯一一个考虑在肝硬化患者中停止 NUC 治疗的组织,如果疾病得到补偿并在仔细的监测计划下[6]。表 11 总结了 EASL、AALSD 和 APASL 对 CHB 患者停止抗病毒治疗的当前建议。"
In non-cirrhotic hepatitis B e antigen (HBeAg)-positive patients, durable HBeAg seroconversion is considered a reliable indicator of sustained response after NUC discontinuation[10]. So, all current guidelines suggest stopping antiviral therapy if seroconversion of HBeAg to anti-HBe is achieved, along with HBV DNA undetectable and normal alanine aminotransferase (ALT) levels, after at least 12 mo of consolidation therapy (up to 3 years according to APASL)[6-8].
In non-cirrhotic HBeAg-negative patients, the EASL guidelines suggest stopping NUCs if the patient had undetectable HBV DNA for at least 3 years and if post-treatment follow-up is guaranteed for at least 1 year[7]. Although AASLD does not recommend NUC suspension in non-cirrhotic HBeAg-negative patients, they included a recommendation of NUC discontinuation if there is a compelling rationale and under careful monitoring every 3 mo for at least 1 year[8]. APASL suggests stopping therapy after at least 2 years of treatment if HBV DNA is undetectable on three separate samples, 6 mo apart[6].
In cirrhotic patients, both EASL and AASLD suggest indefinite long-term therapy while HBsAg persist positive[7,8]. On the other hand, APASL is the only organization to consider stopping NUC therapy in cirrhotic patients if the disease is compensated and under a careful monitoring plan[6]. Table Table11 summarizes current recommendations on discontinuation of antiviral therapy in CHB patients by EASL, AALSD, and APASL.作者: 乙肝人1949 时间: 2022-9-27 19:15