Title : A case of silent chronic hepatitis B following uncontrolled treatment discontinuation: Can antiviral treatment be discontinued in chronic hepatitis B?
Abstract:
Chronic Hepatitis B (CHB) is a significant public health problem affecting approximately 254 million people worldwide and causing 1.1 million deaths annually. Currently, functional cure — defined as HBsAg loss — is achieved at limited rates with existing antiviral treatments; even with ten-year nucleos(t)ide analogue (NA) regimens, this rate remains between 1% and 4%. This reality confronts clinicians with the question of whether to continue or discontinue treatment in patients who have achieved long-term viral suppression.
Studies show that discontinuing treatment under controlled conditions can significantly increase the chance of functional cure, particularly in patients with low HBsAg levels. Large- scale studies such as RETRACT-B reported a 13% HBsAg loss rate at 48 months after NA discontinuation; in the FINITE study, this rate reached 14% in the treatment discontinuation arm. However, the risk of virological relapse remains high, with HBV DNA rebounding in the vast majority of patients, particularly within the first three to six months. The strongest predictor of sustained response following treatment discontinuation has been shown to be HBsAg quantification at the end of treatment; levels below 100–200 IU/mL significantly increase the likelihood of functional cure. In clinical practice, it is well established that in cirrhotic — and especially decompensated — patients, treatment should not be discontinued until HBsAg negativity is achieved, as this group carries substantial risks of severe
exacerbation and mortality.
In conclusion, treatment discontinuation in appropriately selected CHB patients who have achieved long-term virological suppression under NA therapy offers a valuable opportunity for functional cure. However, this decision must be individualized, taking into account the presence of cirrhosis, HBsAg levels, and emerging biomarkers such as HBcrAg. Patients should be closely monitored following treatment discontinuation, and antiviral therapy should be promptly reinitiated if exacerbation criteria are met. Here, we present a case of silent chronic hepatitis B from our clinic in which the patient discontinued treatment on their own initiative.
