What are the criteria for discontinuing antiviral therapy for hepatitis B?
Dec 03, 2025
Source: Cainiu Health
Dr. Gao Jun
Introduction
In general, the criteria for discontinuing antiviral therapy for hepatitis B should be determined through comprehensive assessment of the patient's condition, including negative conversion of virological markers, sustained normalization of liver function, serological marker conversion, sufficient duration of treatment, and improvement in liver histology. Discontinuation of medication must be conducted under a physician's guidance and should not be decided by the patient independently. Regular follow-up examinations are required after stopping treatment to monitor disease progression.
Generally, the criteria for discontinuing antiviral therapy for hepatitis B require a comprehensive assessment of the patient's condition, including sustained viral suppression, persistently normal liver function, serological response, sufficient duration of treatment, and improvement in liver histology. The details are as follows:
1. **Negative virological markers**: Using sensitive detection methods, hepatitis B virus DNA should remain undetectable over time, indicating effective suppression of viral replication. This is the core prerequisite for stopping treatment, which typically needs to be maintained for at least 12 months or longer.
2. **Persistently normal liver function**: Liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) should remain within the normal range over an extended period, indicating controlled liver inflammation and absence of significant hepatocyte damage. This serves as an important basis for treatment cessation.
3. **Serological conversion**: For patients who are hepatitis B e-antigen (HBeAg)-positive, successful treatment requires HBeAg seroconversion—loss of HBeAg and development of anti-HBe antibodies. This is known as "seroconversion." In some cases, loss of hepatitis B surface antigen (HBsAg) may be pursued, which represents a more ideal endpoint and is associated with better long-term outcomes.
4. **Sufficient treatment duration**: Treatment duration varies among individuals. HBeAg-positive patients should generally receive therapy for at least four years, while HBeAg-negative patients often require long-term treatment, usually recommended for more than six years. Even after reaching therapeutic goals, careful evaluation is essential to avoid premature discontinuation and potential relapse.
5. **Improvement in liver histology**: Liver biopsy results should show reduced hepatic inflammation and regression of fibrosis, indicating structural recovery of liver tissue. This histological improvement confirms stable therapeutic efficacy and can serve as an important reference for stopping treatment.
Discontinuation of therapy must be conducted under the guidance of a physician and should never be decided independently. Regular follow-up examinations are necessary after stopping treatment to monitor disease status. Maintaining a regular lifestyle, avoiding alcohol consumption, and refraining from hepatotoxic medications help sustain treatment benefits and protect liver health.
