Sustained HBsAg Loss and Marked Reversal of Liver Cirrhosis in a Patient with Antiviral-Resistant Chronic Hepatitis B: A Case Report with 13-Year Follow-up

Abstract Background Achieving sustained hepatitis B surface antigen (HBsAg) loss and reversing established cirrhosis is considered extremely challenging, especially in patients with prior antiviral resistance. We report a case of marked reversal of liver cirrhosis and sustained HBsAg loss in a patient with chronic hepatitis B (CHB) who previously failed standard antiviral therapy. Case Presentation A 60-year-old male patient was diagnosed with CHB in 2006 and developed cirrhosis after 6 years of standard antiviral therapy at a top-tier hospital. In February 2012, his liver stiffness (FibroScan) was 19.9 kPa, with HBV DNA at 1.47×10^7 IU/ml. He subsequently received combined Chinese-Western medicine ("Neo-Chinese Medicine") treatment. After 7 years and 2 months of treatment, his liver function normalized, HBV DNA became undetectable, and FibroScan decreased to 5.1 kPa. Notably, the patient achieved HBsAg loss and Pre-S1 antigen negativity. All medications were discontinued in April 2019. By November 2020, despite the patient developing hyperlipidemia and steatohepatitis due to lifestyle factors, imaging and elastography confirmed a marked reversal of cirrhosis (FibroScan: 6.2 kPa, normal portal vein diameter of 12 mm) without disease progression. Long-term follow-up up to 2025 consistently showed sustained HBsAg negativity (< 0.05 IU/ml) and undetectable highly sensitive HBV DNA. Conclusion This case demonstrates that Neo-Chinese Medicine can achieve marked reversal of cirrhosis and sustained functional cure in patients with antiviral-resistant CHB. The durability of these outcomes after treatment discontinuation suggests a fundamental restoration of the hepatic microenvironment and the depletion of the viral reservoir.