Hi @Bansah1 ,
Thanks a lot for your concern and i think your concern is right. Just wanna tell you one thing because of that i think Doctor take this decision. My LFT results were always fine just once they went up. I think this is the reason and also doctor said “you have active HBV but it’s not attacking your liver because you have normal lab results”.
I don’t know much about it but i think when virus attack on liver LFT values goes up specially SGPT. So he asked me to do LFT after 2 weeks to just checking if virus is attacking the liver or not.
I don’t know my decision is right or wrong but i just follow the doctor as he has great experience in Heptalogy. Let’s see what gonna happen. But i hope for best.
Again thanks @Bansah1 for you concern. I will update you once i got my next LFT results.
Thanks
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I agree with @Bansah1 that has the potential to cause a flare-up. Also, the chance of HBV clearance when you are HBeAg-positive is much lower compared to HBeAg-negative states. Close monitoring is very important during this period.
Thomas
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Hi @ThomasTu ,
Thanks for your reply and your concern.
I don’t know whether i should ask you or not but Could you please discuss my case with any experienced doctor if it’s possible for you ? Or may be you can give me any reference ? I will share my whole record if needed. I just want to ask you one more question. I know there are some drugs other then TAF but my doctor told me TAF kind of best of them. Do you think if i change drug it’s gonna help me ?
As i talked with 3 doctors all them saying it’s a very different case none of them seen that HBV DNA is positive after taking TAF for 3 years.
But i will check my LFT after 2 week.
Thanks
Probably the best references are meta-analyses into HBsAg seroconversion in HBeAg-positive patients -
APASL guidance on stopping nucleos(t)ide analogues in chronic hepatitis B patients | Hepatology International (see table 2)
https://www.journal-of-hepatology.eu/article/S0168-8278(21)02233-9/fulltext (see table 2)
https://www.gastrojournal.org/article/S0016-5085(19)41872-6/fulltext
The major guidelines suggest that noncirrhotic, pretreatment HBeAg-positive patients can stop NUC therapy after reaching HBeAg seroconversion with undetectable HBV DNA and completing 1–3 years of consolidation therapy.3–5 The guidelines acknowledge that studies supporting these recommendations are of poor quality. Most were long-term retrospective studies that did not correct for selection or measurement bias, with only a few prospective cohort studies. Virtually all studies were from Asia and stopped therapy according to the Asian Pacific Association for the Study of the Liver guidelines, for which reasons to stop treatment were, initially, more economical than scientific. Additionally, patients were retreated at the physician’s discretion rather than with standardized criteria, confounding between-study comparisons.
In these studies, clinical relapse occurred in ≤68% of patients, of whom almost all were retreated (Table 1). HBsAg loss occurred, on average, in 5% annually. In the largest prospective study with 10-year follow-up, 31% of 138 HBeAg-positive Chinese patients experienced virologic relapse, almost all of whom (76%) developed HBeAg seroreversion, attesting that this was not durable at the time of stopping therapy. Although overall 10% of patients achieved HBsAg loss,13 another study in which patients continued NUCs reported even higher HBsAg loss rates after 7 years of therapy.2 In our randomized controlled trial from Toronto, 61% of pretreatment HBeAg-positive patients required retreatment compared with 22% of HBeAg-negative patients (P = .01).12 A systematic review published analogous results: 38% of patients had durable virologic remission at 3 years with 1% HBsAg loss.10 Collectively, these data suggest that the risk of relapse requiring retreatment is high in pretreatment HBeAg-positive patients, even with long consolidation therapy after HBeAg loss.
Regarding the type of drug, all of them appear to be good at reducing viral replication, disease progression, inflammation, etc. They also all have low risk of side-effects. Having multiple options means if you have side-effects to one, then you can switch to another.
Hope this helps,
Thomas