Dear Doctor - I am 42 years old-hepB chronic e-antigen negative, i started pegasys for 1 year because HBV DNA was elevated (> 20000 IU/ml), ALT quite normal always < 35. From the beginning HBV DNA became non dedactable(1st month of therapy) and remained like this until the end. My doctor says that I may need to continue therapy for another 1 year because i am e-antigen negative. What is the optimum decision for me ? (i made also viopsy before therapy showing level 1-2 fibrosis or scarring of liver). Thank you for your attention.

I would make the following comments:

1. PEG is not my first choice for an HBeAg- patient because the risk of relapse if higher than in patients with HBeAg+ infection.

2. There is no data on treatment extended past 48 weeks that I am aware of except some preliminary data in patients with genotype D HBV infection. Still the long-term response rates are not great. Your doctor might know of some other trial I am not aware of, but I would ask.

3. Since your LFTs were not elevated in the beginning, I think you are at risk for relapse.

4. I would favor switching from PEG to an oral agent.

Any agent would probably be fine because you have already achieved viral suppression which is great news. I would stay on that oral agent at least for two more years until more data are available as to the best way to treat patients with E Ag negative infection.

Hope this is helpful.