Because productions of HBsAg and HBcrAg are regulated by different promoter and enhance systems of HBV genome, their clinical values vary. FOLLOW-UP AFTER DISCONTINUATION of NUC includes periodical measurement of HBV DNA levels (real-time PCR) and ALT levels. This study revealed that relapse after discontinuation occurs mostly within 1 year, gradually

decreases after 1 year and rarely occurs after the first 3 years of discontinuation.[6] Therefore, we determined it necessary to pay attention especially to relapse immediately after discontinuation. In particular, we determined that www.selleckchem.com/products/PF-2341066.html it is desirable to follow up patients by blood tests at every 2 weeks up to 16 weeks after discontinuation and every 4 weeks after 16 weeks. One of the important points is what the definition of hepatitis relapse is and how to follow up after discontinuation. Transient abnormalities in the

ALT level or the HBV DNA level may be observed in approximately two-thirds patients who would finally achieve the inactive carrier state. Therefore, even if the ALT or HBV DNA levels show mild elevations, it is possible to follow up without retreatment. However, no criteria have been identified about when to discontinue follow up and start retreatment. We assessed the transitions of ALT levels and HBV DNA levels after discontinuation of NUC by the mean and maximum values to identify the criteria. From this assessment, a strong correlation was shown between the mean and the maximum value in both (Fig. 5).[6] Results of the ROC analysis revealed that the mean ALT 3-deazaneplanocin A mouse of 30 IU/L corresponded to the maximum ALT of 79 IU/L and the mean HBV DNA of 4.0 log copies/mL corresponded to the maximum HBV DNA of 5.7 log copies/mL. Patients with ALT values of not less than 80 IU/L after discontinuation are highly likely to show a mean value of more than 30 IU/L and not assumed to finally meet the criteria

for successful discontinuation. Similarly, patients with HBV DNA value of not less than 5.8 log copies/mL after discontinuation are most likely to show a mean value of more than 4.0 log copies/mL and not assumed to meet the criteria for successful discontinuation. Based on these ID-8 results, we established the condition that patients with ALT value of not less than 80 IU/L or HBV DNA level of not less than 5.8 log copies/mL are less likely to finally achieve the inactive carrier state and should be considered for retreatment with NUC. It is considered that NUC can be discontinued more efficiently and specifically in this condition. Physicians can use more severe criteria at their own discretion in consideration of safety. Less strict criteria also can be used, but it is recommended that the treatment should be done under a certain policy and do not follow the treatment without any aims. THIS MAY BE the first guideline for discontinuation of NUC.