A 55-year-old man with chronic hepatitis B on tenofovir therapy for 3 years has undetectable HBV DNA and normal ALT. HBsAg remains positive. He asks if treatment can be stopped. According to major guidelines, which criterion must be met before stopping nucleos(t)ide analogue therapy in HBeAg-negative chronic hepatitis B?
- A HBsAg seroclearance ✓
- B Anti-HBe seroconversion
- C Normal ALT for 6 months
- D Undetectable HBV DNA for 1 year
Correct answer: A. HBsAg seroclearance
Explanation
In HBeAg-negative chronic hepatitis B, guidelines (AASLD, EASL) recommend indefinite nucleos(t)ide analogue therapy unless HBsAg seroclearance occurs, which is the closest functional cure. Stopping therapy otherwise risks relapse and flares. Anti-HBe seroconversion is not a stopping criterion. Undetectable DNA and normal ALT are treatment goals but not stopping points.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.