Can nucleoside analog antivirals be stopped or not?

The first nucleoside analog antiviral drug, lamivudine, was marketed for clinical application in the treatment of chronic hepatitis B in 1999, and four antiviral drugs, including adefovir, telbivudine and entecavir, have been available since then. The importance of antiviral therapy is emphasized in the Chinese guidelines for the treatment of chronic hepatitis B. More and more doctors and patients are now accepting the concept of antiviral therapy. Nucleoside analogs inhibit viral replication by competitively inhibiting hepatitis B virus polymerase, and do not directly remove the virus. However, long-term treatment with nucleoside analogs carries a certain risk of drug resistance, which increases with the duration of drug use. On the other hand, long-term medication is also a financial burden. Therefore, is it possible to consider discontinuing the drug in patients who are satisfied with the results of certain treatments? How to strike a balance between maximizing the effect of antiviral therapy and reducing the risk of drug resistance and healthcare costs? This is a question worth studying. The so-called satisfactory therapeutic effect generally refers to HBeAg-positive (i.e., major triple Yang) patients, HBeAg seroconversion (i.e., major triple Yang to minor triple Yang), HBVDNA continues to be negative, liver function is normal, and stabilization of at least half a year to more than 1 year; HBeAg-positive negative (i.e., minor triple Yang) patients, HBVDNA continues to be negative, liver function is normal, and stabilization of at least half a year to more than 1 year. Some of the patients in this category can remain stable after stopping the drug, but some of them experience relapse, and current research has found that there are several factors affecting this: 1. HBVDNA load before treatment. The higher the HBVDNA load before treatment, the higher the possibility of relapse after stopping the drug. 2. The time to continue treatment after achieving satisfactory results. If satisfactory efficacy is achieved and treatment is continued for a certain period of time, the likelihood of relapse will be reduced, and the 2010 China Chronic Hepatitis B Treatment Guidelines also point out that prolonging the course of treatment can reduce relapse; 3, age. Some studies have found that the younger the patient, the lower the chance of relapse after stopping the drug, the specific reasons are not yet accurate. 4, the quantitative level of HBsAg at the time of discontinuation. Some studies have found that the degree of decline in HBsAg during treatment and relapse after discontinuation, the lower the level of HBsAg, the lower the risk of relapse after discontinuation Clinically, there are some patients, in order to achieve satisfactory therapeutic effect, subjectively have the need to stop the drug, especially for some of the reproductive requirements of the patient, due to the nucleoside analogs of the impact on pregnancy, many people asked to stop the drug observation. But nucleoside analogues discontinuation is a risky choice, do not arbitrarily stop the drug without authorization, must be under the guidance of clinicians. If you must stop the drug, it is recommended that you comprehensively review the quantitative HBsAg, quantitative HBVDNA and liver function, and if possible, perform a liver tissue biopsy to comprehensively assess the condition of the liver before considering whether to stop the drug. If you are a patient with cirrhosis, it is recommended that you take the drug for a long time or even for the rest of your life, without considering stopping the drug.