Challenges in the discontinuation of chronic hepatitis B antiviral agents

Table 1 Guidelines for stopping nucleos(t)ide analog therapy

Guidelines	HBeAg-positive CHB	HBeAg-negative CHB
APASL 2015[11]	HBeAg seroconversion: + undetectable HBV DNA + normal ALT for ≥ 12 mo (or preferably 3 yr). Cirrhotic patients may be stopped with careful monitoring	Undetectable HBV DNA at least 2 yr with documented on three separate occasions, 6 mo apart: Or HBsAg clearance either at least for 1 yr; Or until anti-HBs seroconversion. Cirrhotic patients may be stopped with careful monitoring
AASLD 2018[10]	HBeAg seroconversion + undetectable DNA + normal ALT for ≥ 12 mo. Not recommended in cirrhosis	HBsAg clearance. Not recommended in cirrhosis
EASL 2017[9]	HBeAg seroconversion + undetectable DNA for ≥ 12 mo. Not recommended in cirrhosis	HBsAg clearance. Or selected noncirrhotic with undetectable HBV DNA ≥ 3 yr. Not recommended in cirrhosis

AASLD: American Association for the Study of the Liver; ALT: Alanine aminotransferase; APASL: Asian Pacific Association for the Study of the Liver; CHB: Chronic hepatitis B; EASL: European Association for the Study of the Liver; HBeAg: Hepatitis B e antigen; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus.