New therapeutic perspectives in HBV: when to stop NAs

The goal of chronic hepatitis B (CHB) treatment is to achieve seroclearance of HBsAg. Nucleos(t)ide analogues (NAs) are one of the first‐line treatments for CHB. NAs produce a potent suppression of viral replication but are associated with a low rate of HBsAg seroclearance and a high risk of virological relapse after discontinuation. Because of these reasons, long‐term treatment is needed. They are well‐tolerated oral drugs, and it seems they do not produce important side‐effects in long‐term administration. The duration of NA treatment remains unclear, nevertheless, in some patients NAs can be stopped with a low rate of relapse. HBeAg‐positive patients could discontinue NA therapy if they achieved HBeAg seroclearance and maintain undetectable HBV DNA. For HBeAg‐negative patients, to stop NA treatment is not recommended. In addition to other factors, serum HBsAg titres during treatment have recently been proposed to guide NA‐based therapy duration in selected patients. All patients could be stopped from taking treatment if they achieve HBsAg loss.