Nonadherence to Antiviral Therapy Leading to Severe Hepatic Decompensation in a Patient With Chronic Hepatitis B

Patients with chronic hepatitis B often require prolonged nucleos(t)ide analogue since functional cure is rarely achieved. Medication nonadherence can trigger life-threatening hepatitis B virus (HBV) reactivation. We report a 58-year-old Asian man with HBeAg-negative chronic hepatitis B and cirrhosis. After 10 years of entecavir therapy, he achieved undetectable HBV DNA and fibrosis regression, but quantitative hepatitis B surface antigen remained >1200 IU/mL. He self-discontinued medication and presented with severe hepatitis reactivation. Liver condition gradually improved on restarting nucleos(t)ide analogue. This case highlights that medication cessation with a high hepatitis B surface antigen titer can precipitate severe hepatitis and liver failure, even after long-term HBV DNA suppression.