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Published on: September 25, 2019
Research progress on hepatitis B surface antigen decline and clearance
Yi-Fan Guo1,2, Meng-Qi Sun1,3, Yi-Zhe Zhang1,3
1Senior Department of Hepatology, the Chinese PLA General Hospital, Beijing 100039, China.
Insights
Achieving hepatitis B surface antigen (HBsAg) loss is key for a functional cure in chronic hepatitis B (CHB). This signifies reduced liver damage and lower liver cancer risk, improving patient prognosis.
Area of Science:
- Hepatology
- Immunology
- Virology
Background:
- Chronic hepatitis B (CHB) is a leading cause of liver cirrhosis and hepatocellular carcinoma (HCC), especially in China.
- The goal of CHB treatment is shifting from viral suppression to functional cure, marked by HBsAg loss.
Purpose of the Study:
- To review HBsAg's role in CHB pathogenesis and prognosis.
- To explore immune mechanisms driving HBsAg decline and clearance.
- To discuss predictive models and strategies for achieving HBsAg clearance.
Main Methods:
- Literature review of recent domestic and international advances.
- Analysis of HBsAg dynamics during antiviral therapy.
- Examination of immunologic mechanisms and predictive models.
Main Results:
- HBsAg clearance correlates with reduced liver inflammation, fibrosis regression, and decreased HCC risk.
- Understanding immune responses is crucial for HBsAg decline.
- Predictive models and targeted therapies are emerging.
Conclusions:
- HBsAg loss is a critical marker for favorable long-term outcomes in CHB.
- Integrated immunologic understanding is vital for functional cure.
- Further research is needed for standardized and precision CHB management.
Abstract:
Chronic hepatitis B (CHB) remains a major global cause of liver cirrhosis and hepatocellular carcinoma (HCC), particularly in China. With ongoing advances in antiviral therapy, the therapeutic objective for CHB has evolved from sustained suppression of hepatitis B virus replication toward achievement of a functional cure, defined by hepatitis B surface antigen (HBsAg) loss with or without anti-HBs seroconversion. Increasing evidence suggests that HBsAg clearance is strongly associated with reduced hepatic inflammation, regression of fibrosis, and a substantially lower risk of HCC, thereby serving as a critical indicator of long-term clinical prognosis in patients with CHB. Drawing upon recent domestic and international advances, this review summarizes the biological characteristics and pathogenic significance of HBsAg, its dynamic changes during antiviral therapy, and its associations with virologic responses and clinical outcomes. Particular emphasis is placed on the integrated immunologic mechanisms underlying HBsAg decline and clearance, including the interplay between innate and adaptive immune responses, cytokine networks, and immune reconstitution during functional cure. In addition, emerging predictive models and potential therapeutic strategies targeting HBsAg clearance are discussed, together with future research directions aimed at advancing standardized management and precision treatment strategies for CHB.
