{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:58:49Z","timestamp":1793051929956,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01AI166126"],"award-info":[{"award-number":["K01AI166126"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R37AI058736"],"award-info":[{"award-number":["R37AI058736"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Discontinuing antivirals in chronic hepatitis B virus (HBV) \u2018e\u2019 antigen negative infection can enhance HBV surface antigen (HBsAg) loss but risks complications. We modelled the clinical impact of discontinuing antivirals in chronic HBV. We developed a Markov state model with Monte Carlo simulation of chronic HBV to compare continuation of antiviral therapy with 3 strategies of cessation and reinitiation for: (1) virologic relapse, (2) clinical relapse, or (3) hepatitis flare. We simulated the probability of virologic relapse as an exponential decay function from the time of antiviral cessation. We used literature\u2010based estimates for input probabilities following virologic relapse: clinical relapse (60%, conditional on virologic relapse), hepatitis flare (57%, conditional on clinical relapse) and HBsAg\u2010loss (6%\u20138%). We projected HBsAg loss, cirrhosis, HCC, and survival. In 10\u2009years, cessation strategies would increase cumulative incidence of HBsAg loss from 4.6% to 12.9%\u201317.3% but would not appreciably change survival (from 90.6% with continuation to 88.1%\u201389.0%). In an undifferentiated population, continuation would be a preferred strategy to increase average life expectancy (by 0.75\u20131.05\u2009years) unless HBsAg loss following treatment cessation was &gt;\u200946%. Sensitivity analyses showed that the decision to continue or stop antivirals would depend on the off\u2010treatment rates of cirrhosis and HCC for people who remain HBsAg\u2010positive but do not fulfil\u00a0retreatment criteria. Careful selection of people for antiviral cessation using quantitative HBsAg levels could improve survival compared with continuation. Clinical practice guidelines should emphasise selective application of antiviral cessation to persons most likely to lose HBsAg without experiencing liver\u2010related complications.<\/jats:p>","DOI":"10.1111\/jvh.70079","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T12:45:57Z","timestamp":1757421957000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Impact of Continuation Versus Cessation of Antiviral Therapy in Chronic Hepatitis B: A Modelling Study With Implications for Hepatitis B Cure"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3761-6154","authenticated-orcid":false,"given":"Amir M.","family":"Mohareb","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Division of Infectious Diseases Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghideon","family":"Ezaz","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur Y.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A.","family":"Freedberg","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Division of Infectious Diseases Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of General Internal Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9512-8928","authenticated-orcid":false,"given":"Anders","family":"Boyd","sequence":"additional","affiliation":[{"name":"Public Health Service of Amsterdam  Amsterdam the Netherlands"},{"name":"Stichting HIV Monitoring  Amsterdam the Netherlands"},{"name":"Amsterdam UMC Location University of Amsterdam Amsterdam Institute for Infection and Immunity (AII)  Amsterdam the Netherlands"},{"name":"Amsterdam UMC Location University of Amsterdam Department of Dermatology  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8721-106X","authenticated-orcid":false,"given":"Emily P.","family":"Hyle","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Division of Infectious Diseases Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28280"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2019.04.002"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.05.008"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-305517"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-019-09989-6"},{"key":"e_1_2_9_7_1","first-page":"1629","article-title":"Discontinuation of Nucleot(s)ide Analogue Therapy in HBeAg\u2010Negative Chronic Hepatitis B: A Meta\u2010Analysis","volume":"71","author":"Hall S. 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