Antiviral therapy for patients with immune active hepatitis b: What, when and is forever?

Hepatitis B is the most common chronic viral infection in the world and leads to significant complications including cirrhosis, hepatic decompensation and hepatocellular carcinoma. Treatment of hepatitis B in patients with immune active disease is recommended in order to decrease the risk of these complications. Antiviral therapies currently available are highly effective in achieving viral suppression and recently updated guidelines from the American Association for the Study of Liver Diseases provide specific criteria for initiating antiviral therapy treatment in patients with chronic hepatitis B. However, once started, the issues of if and when providers can consider discontinuation of antiviral therapy continue to evolve. Increasingly, there is emphasis on treating until HBsAg loss occurs, but this means many patients will be on life-long therapy. A finite duration of therapy is attractive to patients and providers but one must consider the potential risks when stopping treatment. New data continue to inform this question and are reflected in this review.