Discontinuation of Viread (Tenofovir Disoproxil Fumarate) for Chronic Hepatitis B

Primary Discontinuation Criteria

The American Association for the Study of Liver Diseases recommends treatment discontinuation after confirmed HBsAg clearance, regardless of HBeAg status, as this represents the safest endpoint for stopping therapy 1, 2
The European Association for the Study of the Liver suggests that treatment discontinuation should occur after confirmed HBsAg loss, with or without anti-HBs seroconversion, which is the most definitive endpoint for stopping therapy 1, 2

The American Association for the Study of Liver Diseases recommends that discontinuation may be considered in non-cirrhotic HBeAg-positive patients who achieve stable HBeAg seroconversion, undetectable HBV DNA on three separate occasions 6 months apart, and at least 12 months of additional consolidation therapy after HBeAg seroconversion 1, 2, 3, 4
The European Association for the Study of the Liver suggests that discontinuation may be considered in highly selected non-cirrhotic HBeAg-negative patients who have achieved long-term virological suppression (≥3 years of undetectable HBV DNA) and can guarantee close post-treatment monitoring 1, 2

The American Association for the Study of Liver Diseases recommends that treatment discontinuation is not recommended in patients with cirrhosis (compensated or decompensated) due to the risk of hepatic decompensation and death 3, 1
The American Gastroenterological Association suggests that life-long treatment is required for decompensated cirrhosis 6, 7

The American Association for the Study of Liver Diseases recommends intensive monitoring, including liver function tests and HBV DNA by real-time PCR every 1-3 months, and HBeAg and anti-HBe testing every 3-6 months, for at least the first year after stopping treatment 4, 5
The European Association for the Study of the Liver suggests that monitoring should continue beyond the first year, with liver function and HBV DNA checks every 3-6 months to detect viral relapse 4, 5

The American Association for the Study of Liver Diseases recommends never discontinuing therapy in cirrhotic patients unless HBsAg loss is achieved, as life-threatening decompensation can occur 3, 1
The European Association for the Study of the Liver suggests that HBeAg seroconversion alone is not sufficient for safe discontinuation and that consolidation therapy of at least 12 months is required 3, 4, 1