HBV Functional Cure Likelihood — SCE Infectious Diseases MCQ

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ModerateHepatitisHBV Functional Cure LikelihoodSCE Infectious Diseases

A 45-year-old man with HIV (CD4 380, VL <50 on ART) is co-infected with hepatitis B. His HBV is well controlled on Tenofovir AF/Emtricitabine (part of his ART). He asks about the possibility of HBV cure. What is the likelihood of achieving HBsAg loss (functional cure) on nucleos(t)ide analogue therapy?

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Correct answer: B — <5% of patients achieve HBsAg loss on NUC therapy — functional cure is rare; NUCs suppress viral replication but do not eliminate cccDNA from hepatocytes

Nucleos(t)ide analogues (Tenofovir, Entecavir) effectively suppress HBV DNA replication but do not target covalently closed circular DNA (cccDNA) in hepatocyte nuclei — the persistent viral reservoir. HBsAg loss (functional cure) occurs in <5% of patients on NUC therapy over 5–10 years. Novel therapies targeting cccDNA (siRNA, antisense oligonucleotides, capsid assembly modulators) are in clinical trials. For now, patients should be counselled that NUC therapy controls HBV but does not cure it in most cases, and indefinite treatment is usually required.

Reference: NICE CG165 2013 – HBV; EASL 2024 – HBV cure research