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Joon

Meet Joon . . .

  • He is an accountant
  • He is currently single and has no children
  • In his free time, he enjoys volunteering at his community animal shelter

Patient demographics and diagnosis

Sex: Male
Age: 51 years
Race/Ethnicity: Korean American

  • He was diagnosed with CHB at 19 years old (suspected vertical transmission from mother who has CHB)
  • He has been taking an oral nucleos(t)ide (NA) daily for 21 years

    • Born in the US; parents both from Korea and immigrated to the US before he was born
    • Maintains an active lifestyle
    • Abstains from alcohol
    • Has never smoked tobacco or used recreational drugs

    • Mother has CHB and has been on treatment for as long as Joon can remember
    • Joon has no siblings

    • Joon sees his hepatologist regularly for monitoring
    • He has been adherent to his medication and has not experienced drug side effects
    • His abdominal ultrasound and alpha-fetoprotein screening 3 months prior were both normal

    • Physical exam is unremarkable
    • HBsAg (+); anti-HBs (–); HBV DNA, not detected; HBeAg (–); anti-HBe (+)
    • No coinfection with HCV, HDV, or HIV
    • ALT: 30 IU/L (ULN: 35 U/L)1
    1. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599.

  • Vibration-controlled transient elastography:

    • 5.5 kPa (significant fibrosis cutoff, >7.0 kPa)1
    1. European Association for the Study of the Liver. J Hepatol. 2025;83(2):502-583.

Joon tells his hepatologist that he has continued to feel well and has no health concerns. He asks if it would be possible for him to discontinue treatment.

  • You review the recommendations for treatment discontinuation if a patient
    is HBeAg (–):1

    • Continue antiviral therapy until he has loss of HBsAg

    If he wishes to discontinue treatment before loss of HBsAg, the following conditions should be present:

    • No history of cirrhosis, liver cancer, or other complications of liver disease
    • Undetectable HBV viral load for at least 2 years
    • No HIV or Hepatitis D virus (HDV) infection
    • Be willing to adhere to frequent monitoring after stopping

    As Joon is HBsAg (+), you discuss getting his quantitative HBsAg levels evaluated for a more detailed picture1,2

    1. Ghany MG, et al. Hepatology. 2026;83(4):974-997 2. European Association for the Study of the Liver. J Hepatol. 2025;83(2):502-583

  • Quantitative HBsAg: 65 IU/mL

    • Although Joon is HBsAg (+), his quantitative HBsAg results show that his levels are very low
    • HBsAg levels <100 IU/mL in Asian patients at the time of NA cessation are associated with higher rates of spontaneous HBsAg loss1
    • However, if he decides to discontinue NA therapy he will need more frequent lab monitoring, as there is a risk of viral relapse or hepatitis flare after NA cessation.2,3 If this happens, he may need to go back on NA therapy
    • You and Joon together decide that he will continue his treatment. You will continue regular lab monitoring and liver ultrasound, and you will also obtain quantitative HBsAg testing to monitor his levels

    1. Hirode G, et al. Gastroenterology. 2022;162(3):757-771.e4. 2. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599. 3. Hirode G, et al. Am J Gastroenterol 2024;119(9):1849-56.

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