HBV Functional Cure — SCE Infectious Diseases MCQ

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HardHepatitisHBV Functional CureSCE Infectious Diseases

A 40-year-old woman presents with chronic hepatitis B on long-term Tenofovir DF. After 6 years of treatment, her HBsAg quantitative level declines to <100 IU/mL and anti-HBs becomes detectable at 15 mIU/mL. HBV DNA has been undetectable for 5 years. What does this serological evolution suggest?

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Correct answer: D — Functional cure (HBsAg loss with or without anti-HBs seroconversion) — the best treatment outcome achievable with current therapy

HBsAg loss with or without anti-HBs seroconversion is termed 'functional cure' and represents the best achievable outcome with current NUC therapy (occurs in <5% of treated patients). It indicates very low (but not zero) levels of cccDNA in hepatocytes. In patients achieving functional cure, NUC cessation can be considered with close monitoring (HBsAg, HBV DNA, ALT every 3 months for 12 months then 6-monthly). True 'sterilising cure' (elimination of all cccDNA) is not achievable with current therapies.

Reference: EASL 2024 – HBV guidelines; NICE CG165 2013 – Hepatitis B