Defining Virologic Relapse in Chronic Hepatitis B

Abstract

Reappearance of HBV DNA was universal when sensitive HBV DNA assay was used. Waiting 4 weeks to confirm VR may be harmful for patients with a high HBV DNA level, and was ineffective to indicate re-therapy for patients with increase in HBV DNA at a very low level. There is a need for improved and standardized definitions of VR.

KASL clinical practice guidelines for management of chronic hepatitis B

“…They can also be classified as having acute-on-chronic liver failure (ACLF) when they present with symptoms and signs of liver failure [187]. Severe acute exacerbation can occur spontaneously [188], by drug resistant HBV during antiviral therapy [189], by stopping antiviral therapy [190], or by anticancer chemotherapy [191]. NA therapy reduces mortality in patients with severe reactivation of CHB presenting as ACLF [192].…”

KASL clinical practice guidelines for management of chronic hepatitis B

“…They can also be classified as having acute-on-chronic liver failure (ACLF) when they present with symptoms and signs of liver failure [ 179 ]. Severe acute exacerbation can occur spontaneously [ 180 ], by drug-resistant HBV during antiviral therapy [ 181 ], with cessation of antiviral therapy [ 182 ], or with anticancer chemotherapy [ 183 ]. NA therapy reduces mortality in patients with severe reactivation of CHB presenting as ACLF [ 184 ].…”

Stopping Preemptive Antiviral Therapy for Hepatitis B Virus Can Be Considered for Patients with Favorable Predictors

“…There are no widely accepted definitions for ''virological relapse'' for patients who have discontinued preemptive AVT. Virological relapse is often defined as the reappearance of HBV DNA in the serum for those who were undetectable, increase in HBV DNA levels to certain cut-off point (e.g., C2000 IU/mL), or increase more than 1 log in the HBV DNA levels [10,11]. However, these definitions have not been validated and have limitations to be used in patients who discontinue AVT.…”

“…Once AVT with NUC is started in immune-competent patients, NUC discontinuation is frequently associated with virological relapse and biochemical flare [10], so long-term therapy is usually recommended. Meanwhile, indication to start AVT is different in patients receiving cytotoxic chemotherapy.…”