Can Hepatitis B be discontinued or not?

“Doctor, how long do I have to take the medicine? When will I be able to stop taking the medication?” I believe that every hepatologist has heard this question, and in fact, as a hepatologist, every day of my life is dedicated to solving this problem. It is true that only a very limited number of patients with chronic hepatitis B can be cured clinically and stop taking their medication. But that doesn’t mean we need to give up; rather, we need to explore it more deeply. The 2015 hepatitis B guidelines have clearly stated 3 “endpoints”: 1. Desirable endpoint: HBeAg-positive and HBeAg-negative patients with durable HBsAg disappearance with or without HBsAg seroconversion after drug discontinuation. 2.Satisfactory endpoints: HBeAg-positive patients, obtaining sustained virological response and ALT normalization with HBeAg serological conversion after drug discontinuation; HBeAg-negative patients, obtaining sustained virological response and ALT normalization after drug discontinuation. 3. The essential endpoint: long-term maintenance of virological response (undetectable HBV DNA) during antiviral therapy if sustained response after drug discontinuation cannot be obtained. There is no doubt that the basic endpoint is very easy to achieve, and the satisfactory endpoint can be achieved by some patients in our department, but the ideal endpoint is “no rebound of disease after drug discontinuation” that we hope. However, the ideal endpoint is “no rebound of the disease after stopping the medication”. At present, this opportunity is even less available, and I believe this is the endpoint that most of the patients who are taking the medication are looking forward to. Recently, the NEW SWICH study has made some new discoveries that make it very clear which patients on medication may be able to pursue this “ideal endpoint”! The conditions are as follows: 1, after oral antiviral therapy; 2, HBV-DNA (hepatitis B virus) is below the lower limit of detection and has turned negative; 3, HBeAg clearance, i.e. HBeAg (-); 4, HBsAg is less than 1500 IU/ml in these patients with continuous long-acting interferon a -2a, it is possible to achieve safe discontinuation of the drug. Although it is a new clinical observation direction in the field of hepatitis B, it is best to stop the drug as the goal, so that more hepatitis B patients can benefit.