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HBV Functional Cure — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyHBV Functional CureRACP Adult Medicine

A 50-year-old man with chronic hepatitis B (HBsAg positive, HBeAg negative, HBV DNA 3,500 IU/mL) on tenofovir alafenamide for 3 years has undetectable HBV DNA and normalised ALT. He now develops HBsAg loss with anti-HBs seroconversion (HBsAg negative, anti-HBs positive). What does this represent?

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Correct answer: B — Hepatitis D superinfection

HBsAg loss with anti-HBs seroconversion represents 'functional cure' of chronic hepatitis B – the optimal treatment endpoint. It occurs in <5% of patients on antiviral therapy. While covalently closed circular DNA (cccDNA) persists in hepatocytes (preventing true eradication), functional cure is associated with very low risk of viral reactivation and HCC. Antiviral therapy can potentially be ceased 12 months after confirmed HBsAg loss with anti-HBs development, with ongoing monitoring. If HCC surveillance was indicated before HBsAg loss (i.e., established cirrhosis), it should continue regardless.

Reference: Gastroenterological Society of Australia – 2022 – HBV Consensus; AASLD – 2018 – HBV Guidelines