摘要
Nucleos(t)ide analogs(NAs)are one of the first-line treatments for chronic hepatitis B(CHB)infection.NAs are highly efficient in suppressing viral replication but are associated with a low rate of hepatitis B surface antigen(HBsAg)seroclearance and a high risk of post-treatment virologic relapse.As a result,the optimal timing of NA cessation remains unclear,and long-term treatment is often needed.While international guidelines suggest that NA can be discontinued in hepatitis B e antigen(HBeAg)-positive patients who achieve HBeAg seroconversion with undetectable hepatitis B virus(HBV)DNA levels,the recommendations for discontinuing NA treatment in HBeAg-negative patients remain controversial.Furthermore,there is no consensus regarding in whom and when to restart treatment among patients with hepatitis relapse after stopping NA therapy.Recent studies suggest that virologic markers such as HBsAg and hepatitis B core-related antigen(HBcrAg)titers may be useful to guide when to stop NAs in CHB,since both markers appear to correlate with intrahepatic covalently closed circular HBV DNA levels.However,additional studies are required to refine their use.
