0 log copies/mL). It is currently unknown which of the two options for NUC, discontinuation or continuation, AZD1152HQPA is effective on life prognosis or liver carcinogenesis. We established these guidelines to be referred in case of considering discontinuation due to various reasons. We aimed to identify patients with a high possibility of successful discontinuation or patients who should inversely continue the treatment and establish indicators for follow up after discontinuation to avoid risks resulting from discontinuation of NUC as much as possible. The following requirements are determined for discontinuation to previously assume and
avoid the risk of developing severe hepatitis. Both the doctor and the patient fully understand the risk of a high frequency of hepatitis relapse that may become severe. It is possible to follow up as well as to treat appropriately in case of relapse. (Involvement of a specialist is recommended.) The patient has mild hepatic fibrosis with good hepatic functional reserve and will not easily develop severe hepatitis in relapse. (NUC should not be discontinued in patients with hepatic cirrhosis or chronic hepatitis with progressed fibrosis similar to cirrhosis.) Requirements for discontinuation
of nucleoside/nucleotide Y27632 analogs. Almost all patients with high proliferative potential of HBV will relapse after discontinuation. It is essential not to discontinue NUC in these patients and the requirements were determined as follows: (i) HBV DNA level in blood is negative (real-time PCR) at the time of discontinuation; and (ii) hepatitis B e-antigen (HBeAg) level in blood is negative at the time of discontinuation. Urease Condition for duration of treatment period of NUC. Because short-term
treatment with NUC can easily result in relapse, it is recommended to meet the following condition: more than 2 years after the initial administration of NUC. Assessment of relapse risk by scoring of viral antigen levels. For the patients who meet the requirements for discontinuation (HBV DNA negative and HBeAg negative at the time of discontinuation), the HBsAg level and the HBcrAg level at the time of discontinuation can be scored to predict the relapse risk by the following three groups based on the total score. This risk prediction aims to determine whether NUC should be discontinued or not by reference to it to reduce the relapse risk. <1.9 log IU/mL (<80 IU/mL) 1.9–2.9 log IU/mL (80–800 IU/mL) 2.9 log IU/mL (≥800 IU/mL) HBV DNA levels (real-time PCR) and ALT levels must be periodically measured after discontinuation of NUC to pay attention to HBV proliferation and hepatitis relapse resulting from proliferation. Relapse after discontinuation is mostly observed within 1 year and then gradually decreases. It is rare to relapse after the first 3 years. Therefore, it is necessary to pay attention to relapse immediately after discontinuation.