Background and aims: Chronic hepatitis B infection is a global public health challenge,
associated with significant morbidity and mortality. Nucleos(t)ide analogue treatment is crucial
for disease management, but the optimal duration of treatment is currently under debate. This
study aims to assess the treatment rate, identify the proportion of eligible patients for
nucleos(t)ides discontinuation according to the European Association for the Study of the Liver
(EASL) guidelines and examine barriers to implement guidelines in a real-world population
with chronic hepatitis B.
Methods: We analyzed the medical records of all adult patients with chronic HBV infection
examined in our center between 2011 and 2021. Potential eligible patients for antiviral
treatment discontinuation were selected according to the criteria published in 2017 by EASL.
The rates and the predictive factors of lost to follow-up were examined.
Results: Of 506 consecutive patients, 317 (62.6%) were male, median age was 37 years
(interquartile range (IQR) 17 years) and 195 (38.5%) were of African origin. Median follow-up
was 51 months (IQR 75 months). 269 patients (53.2%) were lost to follow-up. Only 8 patients
(1.6% of the total population) in the positive HBeAg group and 17 (3.4% of the total population)
in the negative HBeAg group were eligible for a discontinuation of antiviral treatment according
to EASL guidelines. Only one of these patients has actually attempted interrupting their antiviral
treatment during their follow-up in our center, but they have resumed therapy, due to a
virological relapse.
Conclusion: Discontinuation of nucleos(t)ide analogue treatment in chronic hepatitis B
remains a challenge, particularly in non-cirrhotic HBeAg-negative patients, due to potential
relapse and limited management data. Patient selection is crucial, as only a small fraction of
patients may be eligible for treatment discontinuation, emphasizing the need for further
prospective studies to identify the best candidates.