HBV NUC Cessation After Functional Cure — SCE Infectious Diseases MCQ

Correct answer: E — Cautious discontinuation can be considered with close monitoring — HBsAg loss with anti-HBs seroconversion (functional cure) is the safest stopping point, but monitoring is still needed

The correct answer is E. In chronic hepatitis B treated with a nucleos(t)ide analogue such as tenofovir disoproxil, confirmed HBsAg loss with anti-HBs seroconversion represents functional cure and is the safest point at which treatment cessation may be considered. This is not the same as stopping because HBV DNA is merely undetectable: long-term viral suppression alone usually requires ongoing therapy, especially in HBeAg-negative disease. In UK practice, stopping should be specialist-led and cautious, with continued follow-up for biochemical or virological relapse. Tenofovir should not be stopped unsupervised, and it should generally be continued in patients with cirrhosis or another ongoing indication. Switching to interferon is not required before stopping. Therefore, in this patient with sustained undetectable HBV DNA and confirmed HBsAg loss with anti-HBs seroconversion, cautious discontinuation with close monitoring is appropriate.

Reference: NICE Clinical Guideline CG165: Hepatitis B (chronic): diagnosis and management. Published 2013, last updated 2017. Recommendations 1.5.23, 1.5.24 and 1.6.8. https://www.nice.org.uk/guidance/cg165/chapter/recommendations