Retreatment management for patients with treated relapsed chronic hepatitis B

Most people with chronic hepatitis B receive antiviral therapy for hepatitis B have viral control and stable disease. Because anti-hepatitis B viral drugs cannot completely remove intracellular hepatitis B virus, once the drugs are discontinued, the virus begins to replicate leading to chronic hepatitis B relapse. Various nucleoside (acid) drugs have relapse after discontinuation, and the virological relapse rate after discontinuation is generally around 60%-80%. Although hepatitis B antiviral therapy has the problem of relapse after discontinuation, it remains the key to hepatitis B treatment. Relevant studies have confirmed that the four oral antiviral drugs currently available in China have comparable relapse rates after drug discontinuation. How to provide targeted treatment strategies for this large and specific population has become a key issue for clinical experts to enhance the retreatment management of patients with treated relapsed chronic hepatitis B. Assessment of indications for re-treatment Patients who have stopped medication should be closely monitored for virological relapse, even if ALT/AST is normal, and should be re-treated with antiviral therapy as soon as possible. This is because patients who are treated early can achieve virologic response earlier and prevent clinical relapse and worsening of liver function. Individualized dosing The choice of medication for retreatment should also be based on the response status prior to discontinuation. Patients who respond well and meet the criteria for discontinuation and relapse can be re-treated with their original drugs, which may still achieve the same results as the initial treatment. Of course, it is also possible to choose a combination of drugs with different resistance sites or to choose a more potent antiviral drug to ensure faster inhibition of viral replication and to prevent the occurrence of drug resistance. For patients with clinical relapses, such as young patients with significantly elevated ALT, elevated up to 5 times the upper limit of normal values, interferon therapy can also be used. For patients with poor response to antiviral therapy before discontinuation or passive discontinuation, combination antiviral therapy or more potent antiviral drugs are preferred. Close monitoring Patients who relapse and are retreated should be monitored closely, more frequently than patients on initial treatment, once a month for the first 6 months until virological response is achieved, and once every 3 months thereafter. Monitoring indicators include HBV DNA, ALT/AST, and HBeAg levels.