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HBV Functional Cure — RACP Adult Medicine MCQ

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ModerateGastroenterologyHBV Functional CureRACP Adult Medicine

A 55-year-old man with chronic HBV on TDF for 5 years has been HBeAg negative for 3 years with undetectable HBV DNA. He now achieves HBsAg loss (HBsAg negative, anti-HBs positive). Can antiviral therapy be stopped?

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Correct answer: E — Yes — functional cure achieved, stop treatment

HBsAg loss (functional cure) is the ideal treatment endpoint and is an indication to stop NA therapy. HBsAg loss is durable in most patients and is associated with excellent long-term outcomes. However, HBsAg loss occurs in only ~3-5% of NA-treated patients. After stopping: monitor HBV DNA and HBsAg every 3-6 months for 1 year then annually. cccDNA persists in hepatocytes — complete viral eradication (sterilising cure) is not achieved. HCC surveillance continues if cirrhosis was present.

Reference: GESA – 2022 – HBV; AASLD 2024; EASL 2024