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Chronic Hepatitis B Treatment Cessation — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyChronic Hepatitis B Treatment CessationRACP Adult Medicine

A 60-year-old man with known chronic hepatitis B on tenofovir presents for review. His HBV DNA is undetectable and HBeAg is negative. He asks about stopping antiviral therapy. Under what circumstance can antiviral therapy be safely ceased?

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Correct answer: A — When HBsAg seroconversion occurs (HBsAg loss with anti-HBs development)

The only validated endpoint for safe cessation of antiviral therapy in HBeAg-negative chronic HBV is functional cure: HBsAg loss (ideally with anti-HBs seroconversion). In HBeAg-negative patients, stopping therapy before HBsAg loss carries a high risk of virological relapse and hepatitis flare. Some guidelines consider a finite course in HBeAg-positive patients after sustained HBeAg seroconversion and HBV DNA suppression for ≥12 months, but this does not apply to HBeAg-negative disease.

Reference: Gastroenterological Society of Australia – 2022 – HBV Management Consensus; eTG – 2025 – Gastrointestinal