Nucleoside (acid) drug treatment of patients with successful withdrawal?

In recent years, due to the long term treatment of nucleoside (acid) drugs, there are indeed some patients to achieve the withdrawal criteri

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In recent years, due to the long term treatment of nucleoside (acid) drugs, there are indeed some patients to achieve the withdrawal criteria, treatment success, can be stopped. How should these patients stop? What should be paid attention to during stopping drug?

What are the stopping criteria for nucleoside (acid) drug therapy?

The e antigen positive "HBeAg" patients, after 1 years of treatment, DNA and HBV detection of ALT e antigen, e antibody, if ALT is normal, HBV was not detected by DNA, and the e antigen seroconversion, to continue medication, every 3 months to detect a half ALT, HBV DNA and e antigen, e antibody, more than 1 years to maintain efficacy, can stop drug. If you do not meet the above effects, should continue to take medication, until the curative effect. In view of this, the total treatment must be more than 2 years. For the e antigen negative "small Sanyang" patients, after 1 years of treatment and detection of ALT HBV DNA, if ALT is normal, HBV DNA is not detected, will continue to maintain efficacy of medication, 18 months before the withdrawal, the total treatment must be more than 2.5 years. The latest revision (2007) of the American Society for the study of liver diseases, chronic hepatitis B guidelines that e antigen negative chronic hepatitis B antiviral drugs should continue to surface antigen (HBsAg) disappear and then stop the drug.

How should the patient stop the drug?

Some patients think, gradually reduce the dose or withdrawal before every other day to take can be reduced after discontinuation of rebound. This is a mistake. About 20% of patients who had stopped the drug withdrawal were likely to rebound. The reason for this is that the body's hepatitis B virus has not been completely suppressed. If we reduce or other medication, virus in the body for a long time and low concentration of drug exposure, not only will lead to drug resistance, and the day will certainly rebound. Drug resistant virus rebound after medication is invalid.

Therefore, reach the standard of drug withdrawal in patients if you decide to stop, is completely disabled, do not take the reduction or every other day. If the rebound, re medication is still valid.

How to prevent or reduce rebound after withdrawal?

There are many factors that may affect the rebound after withdrawal. First, after the withdrawal of the rebound and whether to stop the drug standards. About 20% of patients who had stopped the drug withdrawal were likely to rebound, but those who did not meet the criteria for withdrawal could be as high as 80%. Secondly, the rebound after withdrawal was related to the status of e antigen and surface antigen before and after treatment. E antigen positive patients with "big 3 this world" to "small Sanyang" earlier is not easy to rebound, the numerical e antigen before treatment is higher, the faster decline in the more not easy to rebound after treatment before treatment; quantitative antigen on the surface of the lower, after treatment decreased more quickly, after stopping is not easy to rebound and rebound; surface antigen negative almost never. Third, after the withdrawal of the rebound and consolidation treatment time. E antigen positive patients with "big 3 this world" to "small Sanyang", consolidate the treatment time is longer, the smaller the probability of a rebound. Therefore, in patients before and after treatment with the best quantitative detection kit for hepatitis B five of the value of imports, the changes were observed during the treatment period, reached the standard of withdrawal after as long as the conditions to extend the consolidation treatment time, achieve the best surface antigen disappearance and withdrawal.

No matter what factors are associated with rebound after withdrawal, patients need to be monitored after withdrawal. Check the liver function and HBV DNA once a month after the general withdrawal, the most likely rebound in the time after the withdrawal of 3 to 6 months. If after half a year has not yet rebounded, the frequency of monitoring can be reduced to 2 to 3 months at a time; if after 1 years has yet to rebound, can be identified as the withdrawal of success, but still need every 6 to 12 months of monitoring, to alert the activity of hepatitis B virus.

 

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