My blood test results showed the HBsAB is 16.05 mIU/mL, the HepBsAG is non-reactive, the Hep B core total is Reactive, both Hep B virus DNA ultra quant RT PCR and Hep B virus DNA quant PCR are not detected, the ALT is 11. The ultrasound showed everything is normal. Here is the ultrasound result for liver - normal morphology and parenchymal echogenicity. No focal lesion.
Portal vein: main protal vein is patent in its visualized portion, with normal direction of flow. I’ve been on tenofovir disoproxil 300 for over 10 years. With the result above showed, can I stop taking the med? Are there any risk for Hep B to reactivate if I stop taking the TDF?
BTW, I’m new to this forum. I’m not seeking any medical advise. I’ve already had a discussion with my doctor yesterday, but he still ask me to continue taking the TDF. If I’m currently functional cure, would TDF cause more harm to my liver and kidney? Should I seek a different doctor for 2nd opinion?
Hi @watchtowerdocker935,
Welcome to the community. It will all depend on how long you had these results. In other to stop taking your antivirals it is recommended that you should have a normal test for HBsAB and HBsAG, plus normal LFT’s and a clean imaging for 6 months I think. During this period you will continue taking your antivirals. So while you are onto something, you just cannot stop treatment without making sure that these tests remain consistent for some months. I hope it makes sense. In this case I agree with your doctor until you get through a period of testing. Stopping treatment is not based on just one normal test but multiple and consistent results. Best, Bansah1.
Congratulations on your results, they are indeed consistent with a functional cure/clearance of HBV infection. It is best to talk to your doctor, as they will need to confirm that it is long-lasting loss of HBsAg before you stop treatment. That said, these are very good signs!
Would be great if any @HealthExperts want to comment further.
Cheers,
Thomas
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Thank you, Bansah1 and ThomasTu, for your valuable advice. I appreciate your insights.
I’ve been cautious about discontinuing the antiviral medication. When I discussed this with my doctor yesterday, he said, “It’s indeed a great result… but we don’t want the virus to come back.” This led me to wonder: if HBsAg has turned negative and HBsAb is positive, is there still a risk of HBV reactivation if I stop taking Tenofovir?
I’m comfortable continuing the medication, as I haven’t experienced any adverse effects from TDF so far. However, I’m slightly concerned about the long-term impact on my liver and kidneys if there is nothing for the medication to actively suppressing.
@ThomasTu, I’ve read many of your posts and greatly appreciate your contributions to this community. I’ve learned a lot from you. If I understand correctly, I believe HBV infection should not recur in my situation. Could you confirm if this understanding is accurate?
My main questions are:
What is the risk of HBV reactivation given my current status (HBsAg negative, HBsAb positive)?
Are there potential long-term effects of continuing Tenofovir when the virus appears to be cleared?
After confirmed (6 months) full seroconversion (HBsAg neg, antiHBs >100 units…) the risk of spontaneous reactivation of HBV (HBsAg seroreversion) is low but monitoring is required fo some time. However, there is still a risk of HBV seroreversion and HBV-related hepatitis in case of immunosuppression, as low level active intrahepatic replication of HBV continues despite HBsAg negativity and antiHBs production
regards
Prof. Pietro Lampertico, MD, PhD
Full Professor of Gastroenterology
Chief, Gastroenterology and Hepatology Division
Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico
Director, CRC “A. M. and A. Migliavacca” Center for Liver Disease
Department of Pathophysiology and Transplantation
University of Milan
Via Francesco Sforza 35
20122- Milan
Italy
Phone +390255035432
Fax +390250320410
Email pietro.lampertico@unimi.it
Hi Dr. Lampertico, thanks for the detailed explanation. If I understand correctly, there is still possibility for HBV to come back if I stop the treatment? Sorry for all the questions. There are not many resources on the internet for what should be done after the functional cure, other than monitoring. One of my concern is if there is a chance to build resistance to the TDF if stop taking it for a period of time, when the virus come back?
FYI, I went to do another test with a different lab. Just in case to avoid the false negative result. The results are the same for surface antigen - non reactive; surface antibody immunity is 49 mIU/ML (it has gone up); the DNA, QN and realtime PCR are non detected. After this test, my doctor has advised me to continue taking the TDF for another 6 months.
Again, sorry for all the questions. I’m thrilled with my lab results, yet simultaneously feeling a bit anxious about what steps to take next.
I found this paper, https://www.cghjournal.org/article/S1542-3565(19)30908-5/fulltext. After I read it, I have gained better understanding about the functional cure. The HBsAg seroreversion is possible. For example, in one of the largest study, amount of all HBsAg loss patients, 75 out of 1846 them had HBsAg seroreversion (HBsAg reactive again) in 23 months. Although the percentage is small, about 4%, there still chance.
The paper didn’t mention anything about if the patient should continue the antiviral therapy, or any of the concerns I listed before.
Sigh… Despite the incredible news of achieving functional cure, my journey has been marked by moments like this - where every step forward brings with it a new wave of uncertainty. When I got the latest lab results, it was a double-edged moment: on one hand, I felt relieved and grateful for the progress; on the other, I couldn’t shake off the feeling of unease about what comes next. As I mentioned above, I’m following my doctor’s advice to continue taking the TDF for another 6 months.
The only additional comments are:
- There should be 6 months of continual HBsAg loss before removal of TDF (at least two HBsAg tests spaced 6 months apart).
- Follow-up should be monthly for the first 6 months.
- Although unlikely, ALT flares (regardless of magnitude) even if accompnied by a mild HBV DNA flare (< 2000 IU/mL) and with normal bilirubin, albumin and INR should be tolerated without starting NUC therapy again.
Good luck!
I would continue TDF for 6 additional months or at least to reach antiHBs levels >100, then you could probably stop TDF ma monitoring is required
Dear @watchtowerdocker935,
Your understanding is correct. HBsAg loss (if shown for at least 6 months) is a really stable state and the risk of reactivation is very low. The fact that you are anti-HBs positive and HBV DNA undetectable (with a high sensitivity assay) further reduces your risk of reactivation.
Any reactivation can be treated easily and quickly with antiviral therapy; there are no described cases of TDF resistance. There is no evidence that I am aware of that shows that antiviral therapy would reduce the risk of reactivation in this context.
I understand that there is discomfort in uncertainty, but it will get better with time.
Hope this helps,
Thomas