Prognosis

Globally, there were 1.1 million hepatitis B virus (HBV)-related deaths in 2022, mostly from cirrhosis and hepatocellular carcinoma.[10]

Patients with acute HBV infection

More than 95% of immunocompetent individuals with acute infection will achieve seroconversion with appearance of antibody to hepatitis B surface antigen (anti-HBs) in the absence of treatment.[3]​​[39]

Patients with hepatitis B e antigen-positive chronic HBV infection

The end point of treatment is well defined in this patient population, based on predictability and durability of seroconversion to antibody to hepatitis B e antigen (anti-HBe). When treatment is stopped after seroconversion is achieved, viral suppression is sustained in 50% to 90% of patients. Seroconversion is associated with maintained long-term improvement in liver histology.[157] However, true cure (loss of hepatitis B surface antigen and anti-HBs) occurs in a very low percentage of treated patients (1% to 5%).[24][158]

Patients with hepatitis B surface antigen-negative chronic HBV infection

The end point of treatment for this group of patients is poorly defined. Therefore, treatment duration is prolonged and probably needs to be lifelong unless there is a compelling reason to stop treatment after carefully weighing the risks and benefits. In addition, relapse with this group of patients is frequent even when there is complete viral suppression after discontinuation of drugs (undetectable HBV DNA) for >1 year.[3]

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