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Hepatitis B Surface Antigen Loss and Improved Clinical Outcomes in Asians with Chronic Hepatitis B Virus Infection

Wallis Lau1,2,3, Myriam Drysdale4, Eleonora Morais4

  • 1Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China.

Gastro Hep Advances
|January 5, 2026
PubMed

Insights

Hepatitis B surface antigen (HBsAg) loss significantly reduces the risk of liver disease, cancer, and death in chronic hepatitis B patients. This functional cure marker indicates improved long-term clinical outcomes.

Area of Science:

  • Hepatology
  • Virology
  • Public Health

Background:

  • Chronic hepatitis B virus (HBV) infection presents a significant global health burden.
  • Hepatitis B surface antigen (HBsAg) loss is a critical indicator of functional cure in HBV treatment.
  • Further research is needed to understand the clinical impact of HBsAg loss.

Purpose of the Study:

  • To investigate the association between HBsAg loss and clinical outcomes in patients with chronic HBV infection.
  • To evaluate the impact of HBsAg loss on compensated cirrhosis, decompensated liver disease (DLD), hepatocellular carcinoma (HCC), and all-cause mortality (ACM).
  • To assess changes in healthcare resource utilization following HBsAg loss.

Main Methods:

  • A population-based cohort study utilizing electronic health records from Hong Kong (2005-2019).
  • Inclusion of 71,077 patients with chronic HBV infection.
  • Application of a marginal structural model with inverse probability weighting to adjust for confounders and estimate hazard ratios (HRs).

Main Results:

  • HBsAg loss was associated with a significant reduction in the risk of DLD (74%), HCC (66%), and ACM (26%).
  • The hazard ratio for compensated cirrhosis was 0.57 (95% CI 0.30-1.14).
  • Each additional month of HBsAg loss correlated with decreased risk of HCC and ACM; healthcare resource utilization decreased post-HBsAg loss.

Conclusions:

  • HBsAg loss is strongly associated with reduced risks of DLD, HCC, and ACM in chronic HBV patients.
  • The findings support HBsAg loss as a key marker for favorable long-term clinical outcomes in chronic hepatitis B management.
  • This study highlights the importance of monitoring HBsAg status for assessing treatment efficacy and patient prognosis.
Abstract

Keywords:
AsianClinical OutcomesHBsAg Loss

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